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KANSAS GOVERNMENTAL ETHICS COMMISSION
RECEIPTS AND EXPENDITURES REPOR OF A POLITICAL OR PARTY COMMITT E
January 10, 2012 JAN 102012
FILE WITH SECRETARY OF STATE SE~~~A~KOBACH SEE REVERSE SIDE FOR INSTRUCTIONS . YOfCSTATE
A. Nanle of Committee: Kansas Insurance Agents Political Action Committee
Address: 815 SW Topeka Blvd
City and Zip Code: Topeka KS 66612
This is a (check one): __ Party Committee .f Political Committee
B. Check only if appropriate: __ Amended Filing __ Termination Report
C. Summary (covering the period from January 1,2011 through December 31,2011)
1. Cash on hand at beginning ofperiod .
2. Total Contributions and Other Receipts (Use Schedule A) .
3. Cash available this period (Add Lines 1 and 2) .
4. Total Expenditures and Other Disbursements (Use Schedule C) .
5. Cash on hand at close ofperiod (Subtract Line 4 from 3) .
6. In-Kind Contributions (Use Schedule B) $0.00
7. Other Transactions (Use Schedule D) $0.00
$23,900.99
$26,711.75
$50,612.74
$10,318.19
$40,294.55
D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best ofmy knowledge and belief is true, correct and conlplete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."
1/10/2012 Date
GEe Form Rev, 2001
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Cuh
Check Appropriate Box
Check LOaD Other
Amount of Cash, Check,
Loan or Other Receipt
8/12/11 1st Choice Insurance Agency 105 W. Main Norton,KS 67654
$75.00
1/30/11 5Star Specialty Products 906 S. Kirkwood Dr. St. Louis, MO 63122
$75.00
9/26/11 AASI Insurance, Inc. 2820 SE 29th Topeka, KS 66605-2263
$75.00
9/12/11 ABK Insurance Agency, Inc. 3339 SE Adams St. Topeka,KS 66605-1276
$75.00
10/26/11 Acuity 1202 Old Hawthorne Dr. E Columbia, MO 65201
$75.00
8/25/11 Affinity Choice Insurance Group 404 S. 3rd Sf. Burlington, KS 66839-1906
$75.00
5/23/11
9/30/11
AFS/IBEX 1185 Lewis Rd. Geneva, IL 60134
Agency West Insurance 11267 Strang Line Rd. Lenexa, KS 66215-4040
$75.00
$93.75
9/26/11 Albright Investment Co., Inc. P.O. Box 642 Winfield, KS 67156-0642
$75.00
7/20/11 'All Insurance Access LLC 3706 SW Topeka Blvd. #411 Topeka, KS 66609-1239
$75.00
12/19/11 Allen Insurance Associates, Inc. 2153 SE California Topeka,KS 66605-1753
$75.00
$843.75
Page _1_ of 33>
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
11/10/11 Allied Ins - A Mbr of N~tionwide
PO Box 80758 Lincoln NE 68501
12/10/11 Allstate Insurance Company PO Box 246 Viola KS 67149
8/3/11 Almena State Bank 500 Main Almena KS 67622-0127
12/9/11 Alternative Risk Company Inc PO Box A Independence MO 64051
2/4/11 Alternative Risk Services (ARS) 10525 N Ambassador Dr- Ste 300 Kansas City MO 64153-1284
10/20/11 American Mining Insurance Co 3490 Independence Dr Birmingham AL 35209
8/18/11 AOPA Insurance Agency Inc 1995 Midfield Rd Wichita KS 67209
8/1/11 ARS Agency Inc 7540 W 160th St - Suite 100 Stilwell KS 66085
8/12/11 Atkins Insurance Agency 3 EWali St Fort Scott KS 66701
7/2111 W E Avery Agency 201 N Walnut Peabody KS 66866-0131
Occupation & Industry of Individual Giving More
Than $150
Check Amount of Appropriate Box Cash, Check,
Loan or Calh Check Loa. Other
Other Receipt
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00.f I
$75.00
$75.00
$75.00
$750.00
Page _2_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Name and Address Date of Contributor
7/25/11 AutoSure Inc 900 S Second Dodge City KS 67801
7/28/11 Ayres Insurance Agency LLC 201 Starr Ave Miltonvale KS 67466
7/28/11 Backman-Bishop Agency 2632 Tumbleweed Rd Vermillion KS 66544
7/20/11 Baldwin Insurance Services 802 Ames St Baldwin City KS 66006
8/10/11 Banco Insurance Agency 201 N Main Haviland KS 67059
11/8/11 Bartel Insurance Agency 113 W Grand Ave Hillsboro KS 67063
8/12/11 Raymond Bauer Agency Inc 204 Elm St Burdett KS 67523-0085
12/9/11 Beasley Insurance Inc 2336 Ridge Ct Lawrence KS 66046-3983
12/14/11 . Bendena Insurance Agency 202 Commercial Bendena KS 66008
Occupation & Industry of Individual Giving More
Than $150
Check Appropriate Box
Calh Check Lou Other
Amount of Cash, Check,
Loan or Other Receipt
$75.00
$75.00
$75.00
$75.00
$75.00
$93.75
$112.50
$75.00
$75.00
$731.25
Page _3_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Amount ofOccupation & Industry of Check Appropriate Box Cash, Check,Name and Address Individual Giving More
Date of Contributor Than $150 C.... Check Lou Other
Loan or Other Receipt
8/12/11 Bergkamp Insurance Center, Inc. 300 N. Main St. South Hutchinson, KS 67505
$75.00
7/20/11 Berkley & Berkley Agency 104 S. Main Tescott, KS 67484
$75.00
12/29/11 Berkshire Hathaway-Homestate 3333 Farnam St. Suite 300 Omaha, NE 68131
$150.00
8/31/11 Bieker Insurance Agency, Inc. 107 W. 13th St. Hays, KS 67601
$75.00
12/28/11 Billiard Hammer Hartman Ins. 20 S. National Fort Scott, KS 66701
$75.00
7/25/11 Blue Valley Ins Agy-Hanover Ins P.O. Box 336 Hanover, KS 66945-0336
$75.00
9/19/11 Bob Dittman Insurance Agency 121 W. 5th St. Pittsburg, KS 66762
$75.00
7/21/11 Bolinger Agency 120 N. Main Bucklin, KS 67834
$75.00
8/20/11 Bolz Insurance, Inc. 622 Topeka Lyndon, KS 66451
$75.00
12/30/11 Bovard Insurance Group LLC 6950 Squibb Rd. #200 Mission, KS 66202
$75.00
8/18/11 Boxler Insurance Agency, Inc. 108 N. First Norton,KS 67654
$75.00
$900.00
Page _4_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Amount ofCheckOccupation & Industry of Cash, Check,Name and Address Individual Giving More Appropriate Box
Loan orDate of Contributor Than $150 Casll Cileck Loaa Other
Other Receipt
Bridges Group, Inc. ¥
9/26/11 117 N. Kansas $75.00 Norton, KS 67654
Brier Payne Meade Insurance, Inc 12/29/11 $75.005835 SW 29th St. Suite 101
Topeka, KS 66614
Brown Business Services, Inc. 10/31/11 $75.00127 E. 6th St.
Concordia, KS 66901
Builders Ins Consultants, Inc. $75.0012/19/11 1100 Walnut, Suite 3010
Kansas City, MO 64106
Buterbaugh & Handlin $56.2512/21/11 B08 Millington
Winfield, KS 67156
C. Ray Tyler Agency, Inc. 8/16/11 199"9 N. Armidon, Suite 121 $75.00
Wichita, KS 67203
C.D. Schulte Agency, Inc. $75.0011/16/11 114-116 W. 4th St.
Garnett, "KS 66032
C.D. Williams & Co. 3400 College Blvd. Suite 200 12/28/11 $93.75 Leawood, KS 66211
C. Dean Riney Insurance, Inc. 10/31/11 1011 N. Kansas $56.25
Liberal, KS 67901
CFI $93.7511/17/11 2143 E. 151st St.
oI'athe, KS 66062
Calvin, Eddy &Kappelman, Inc. $56.2512/28/11 1011 Westdale Rd.
Lawrence, KS 66049
$806.25
Page _5_ of 6~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Cuh
Check Appropriate Box
Cheek Loa. Other
Amount of Cash, Check,
Loan or Other Receipt
12/20/11 Campbell Agency 614 Cedar Cedar Vale, KS 67024
$93.75
9/22/11 Campbell Insurance Agency 220 Center Oakley, KS 67748-1714
$75.00
7/29/11 Capitol Agency 9500 Nail Ave. #305 Ovel1and Park, KS 66207
$75.00
9/16/11 Cardinal Insurance Co., Inc. 332 W. 7th Junction City, KS 66441
$75.00
8/11/11 Carpenter &Co 8301 State Line Rd. Suite G-A Kansas City, MO 64114
$75.00
11/14/11 Carson Insurance Group 122 W. Main Mulvane, KS 67110-0158
$75.00
7/28/11 Case &Son Insurance, Inc. 220 E. Main Marion, KS 66861
$75.00
12/6/11 Castleberry Insurance LLC 7920 W. Kellogg, Suite 401 Wichita, KS 67209
$93.75
8/20/11 CBIZ Insurance Services 11440 Tomahawk Creek Pkwy. Leawood, KS 66211-2672
$150.00
11/8/11 Central Insurance 222 W. 8th Coffeyville, KS 67337
$67.50
7/29/11 Central Insurance Agency P.O. Box 68 Tipton, KS 67485-0068
$75.00
$930.00
Page _6_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150
Check Appropriate Box
Amount of Cash, Check,
Loan or Other Receipt
Calh Check LoaD Other
7/25/11 Cersovsky InsLJrance, Inc. 370 N. Franklin Colby, KS 6770
$75.00
12/13/11 Charlsen Insurance Agency, Inc. 304 Main Halstead, KS 67056
$56.25
8/30/11 Charlson-Wilson Ins Agency 555 Poyntz Ave. Suite 2 05 Manhattan, KS 66502-0023
$75.00
12/14/11 Chris-Leef General Agency, Inc. 11503 W. 75th St. Shawnee,KS 66203
$75.00
8/3/11 Citizens Insurance Agency 124 E. Commercial Waterville, KS 66548
$75.00
12/6/11 Citizens Ins Services Tomlind Co. 122 N. -6th Osage City, KS 66523
$93.75
10/21/11 Clarence L. Gile Agency 317 4th St. Scandia, KS 66966
$93.75
12/2/11 The Clements Agency 816 US Hwy 59 Atchison, KS 66002
$75.00
8/24/11 Cline-Wood Agency, Inc. 4300 W. 133rd St. Leawood, KS 66209
.f $75.00
7/25/11 Cockrum Insurance Agency 202 S. Main Johnson,KS 67855
.f $75.00
4/17/11 Coffey County Insurance LLC 300 Neosho Burlington, KS 66839
$150.00
$918.75
Page _7_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than 5150 Cash
Check Appropriate Box
Check Loa. Other
Amount of Cash, Check,
Loan or Other Receipt
9/20/11 Cohen Brokerage LLC 4120 W. 54th St. Roeland Park,.KS 66205
$75.00
9/14/11 Commercial Insurance Assoc Inc. 410-D SE 3rd St. Suite 104 Lee's Summit, MO 64063
$75.00
12/28/11 Commercial Risk Associates, Inc. 135 Oak St. Bonner Springs, KS 66012
$56.25
8/25/11 Community Insurance Service Inc. 309 Maple Overbrook, KS 66524
$75.00
9/28/11 Compass Insurance Services 13095 S. Mur-Len Rd. Suite 100 Olathe, KS 66062
$75.00
9/22/11 Conrad Insurance Agency 10701 Barkley St. Overland Park, KS 66211
$75.00
8/5/11 Conrade Insurance Group, Inc. 129 E. Broadway, Suite 200 Newton, KS 67114
$75.00
11/2/11 Continental Western Group 3641 Village Dr. Lincoln, NE 68516
$75.00
10/27/11 Cornerstone National Ins. Co. 3100 Falling Leaf Ct. Suite 200 Columbia, MO 65201
$75.00
9/30/11 Corns & Ballard Agency 240 S. Main Greensburg, KS 67054-1726
$75.00
10/1/11 Corporate Assurance, Inc. 6811 Shawnee Mission Pkwy 307
.Overland Park, KS 66202 $93.75
$825.00
Page_8 _of ~
SCHEDITLEA CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
7/25/11 Corporate Insurance Group Inc 15357 Carter Overland Park KS 66221
9/6/11 Cowell Insurance Group Inc 10525 N Ambassador Dr- Ste 301 Kansas City MO 64153-1284
8/5/11 Cowell Insurance Services Inc 13955 Meadow Cir Leawood KS 66224-4580
12/14/11 Cretcher Heartland LLC 4551 W 107th St - 3rd Floor Overland Park KS 66207
8/22/11 Cushing Insurance Agency Inc 800 N Morgan Downs KS 67437
8/25/11 Dornes Insurance Agency LLC 1508 Hwy 59 - Suite B Princeton KS 66078
11/4/11 Double C Agency 117 N Main Moline KS 67353
8/29/11 I Double Eagle Insurance Svcs Inc
7070 W 107th St - Suite 200 Overland Park KS 66212
7/28/11 Eberle Insurance Agency 272 Main Grainfield KS 67737
7/29/11 Eck Agency Inc 123 N Main Attica KS 67009
Occupation & Industry of Check Amount of Individual Giving More Appropriate Box Cash, Check,
Than $150 Loan or Ca.1a Check LoaD Other
Other Receipt
$75.00
$75.00
$75.00
$93.75
$75.00
$75.00
$93.75.f I
.f $75.00
$75.00
$75.00
$787.50
Page _9_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Cas"
Check Appropriate Box
Check Lou Other
Amount of Cash, Check,
Loan or Other Receipt
9/6/11 Edie Insurance Group 3109 W 6th St - Suite B Lawrence KS 66049
$93.75
8/12/11 Eklund Insurance LLC 1617 Clark Goodland KS 67735
$75.00
7/28/11 Elliott Insurance Agency Inc 207 N Main McPherson KS 67460
$75.00
9/12/11 Elliott Insurance Group 278 Fairlane Dr Louisburg KS 66053-0639
$75.00
1217/11 Evans Agency 112 W St John Girard KS 66743
$75.00
8/9/11 Evans Insurance Agency 22 W Broadway Lebo KS 66856
$75.00
9/19/11 Evans Real Estate Co Inc 502 E 4th Tonganoxie KS 66086
$75.00
12/29/11 Executive Brokers Ins Svcs Inc 1240 Jungermann Rd St Peters MO 63376
$150.00
7/25/11 Fairview Insurance Agency 412 W Commercial Fairview KS 66425
$75.00
7/25/11 Farmers Crop Insurance LLC 651 E Industrial Trafficway- Ste 2 Rossville KS 66533
$75.00
12/28/11 Farmers Mutual Insurance Co 16 N Main Ellinwood KS 67526
$75.00
$918.75
Page~of b1
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Amount of Name and Address
Occupation & Industry of Check Cash, Check,
Date of Contributor Individual Giving More Appropriate Box
Loan orThan $150 c.... Check Lo.a otiter Other Receipt
Felts Insurance Agency 10/7/11 710 W 11th $75.00
Coffeyville KS 67337
Financial Strategies Inc 7/25/11 100 S 4th St $75.00
Leavenworth KS 66048
First Group Insurance Inc 8/9/11 136 S Broadway $75.00
Sterling KS 67579
First Insurance Agency Inc 7/29/11 108 E Main $75.00
Mount Hope KS 67108
First Ins Agency of Hoxie Inc 12/8/11 700 Main $56.25
Hoxie KS 67740
First Insurance of Leoti 8/4/11 102 S 2nd St $75.00
Leoti KS 67861
First Insurance Inc 7/25/11 133 S Main $75.00
Smith Center KS 66967
First State Insurance Agency 9/20/11 115 S Topeka $75.00
Burlingame KS 66413
First Tribune Ins Agency Inc 8/16/11 118 W Greeley Ave $75.00
Tribune KS 67879
FirstComp Insurance Company 11/21/11 222 S 15th St - Suite 1500 $75.00
Omaha NE 68102
$731.25
Page _1_1_ of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(N arne of Party Committee or Political Committee)
Amount ofOccupation & Industry of Check Cash, Check,Appropriate BoxName and Address Individual Giving More
Loan orDate of Contributor Than $150 Cub Cbeck Loa. Other
Other Receipt
Flint Hills Insurance Agency 8/16/11 103 N Main $75.00
Eskridge KS 66423
Foltz-Roepke Insurance Inc $75.0012/6/11 1335 S Kansas Ave
Topeka KS 66612
Fouts Ins &Citizens State Agency 8/29/11 121 E Main $75.00
Beloit KS 67420
Fox Insurance Agency $93.7512/21/11 420 E Washington
Arma KS 66712
Frederickson Insurance Agency $75.008/22/11 183 S Penn
Oberlin KS 67749
Frewen Insurance Agency 7/29/11 115 W Washington $75.00
St Francis KS 67756
Fritz Ins Agency dba SPA Ins $112.5010/28/11 1131 SW Winding Rd #600
Topeka KS 66615
Fuqua Ruth Typer 10/15/11 100 N Lancaster $75.00
Hesston KS 67062-8954
Garry & Assoc Insurance Agency 8/18/11 135 E 20th Ave $75.00
N Kansas City MO 64116-3412
Graham-Rogers Inc $75.0010/24/11 PO Box 1628
Bartlesville OK 74005
Great Plains Agency LLC $75.009/14/11 375 8th Rd
Bushton KS 67427
$881.25
Page~of 33
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Amount ofOccupation & Industry of Check Cash, Check,Appropriate BoxName and Address Individual Giving More
Loan orThan $150Date of Contributor c.... Cbeck Lo.. Ot"er Other Receipt
Grinnell Insurance Agency LLC 8/6/11 PO Box 365 $75.00
Grinnell KS 67738-0365
Gross Insurance Agency 9/17/11 105 S 4th $75.00
Manhattan KS 66502-6109
Gross Insurance Agency Inc 12/28/11 18 S National Ave $75.00
Fort Scott KS 66701-1309
H & H Insurance Agency 12/2/11 2 Old Fort Blvd $56.25
Fort Scott KS 66701
Hagerty Rose & McPherron Inc 9/6/11 106 W 11th St #1250 $75.00
Kansas City MO 64105
Halpin & Company 8/22/11 10701 Barkley $75.00
Overland Park KS 66211
Hanston Insurance Agency Inc 8/22/11 102 N Logan $75.00
Hanston KS 67849
Harkness Insurance Inc 8/1/11 119B S Pennsylvania $75.00
Ness City KS 67560
Harley D Huggins Agency 8/24/11 5316 Lakewood St $75.00
Kansas City KS 66106-2116
Harrison Brothers Agency LLC 7/21/11 900 N Morgan $75.00
Downs KS 67437
$731.25
Page~of 33
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 C.III
Check Appropriate Box
Check Lou Other
Amount of Cash, Check,
Loan or Other Receipt
9/23/11 Haskell County Agency LLC 108 N Inman Sublette KS 67877
~
$75.00
9/15/11 Hattrup Ag Services Inc 313 Colony Kinsley KS 67547
$75.00
8/24/11 Haven Insurance Agency Inc 101 N Kansas Ave Haven KS 67543
$75.00
3/25/11 HCC Surety Group 601 S Figueroa St - Suite 1600 Los Angeles CA 90017
$75.00
7/25/11 Heaty Insurance Inc 4004 W Hwy4 Healy KS 67850-5060
$75.00
10/24/11 Heartland Adjustment Inc PO Box 2666 Salina KS 67402
$75.00
10/28/11 Heartland Crop Insurance 120 SE 6th - Suite 2-210 Topeka KS 66603
$75.00
10/5/11 Hedges Insurance Agency 1035 Vermont St #A Lawrence KS 66044-2921
$75.00
7/28/11 Heilman tnsurance Agency 507 Court Clay Center KS 67432
$75.00
8/29/11 Heiman Insurance Agency 611 N 2nd St Seneca KS 66538
$75.00
8/10/11 Heinze & Assoc Insurance Inc 102 S Main Luray KS 67649
$75.00
$825.00
Page ~ of 3>3>
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne 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 LoaD Other
Other Receipt
Heritage Insurance Group Inc 8/5/11 105 N Douglas $75.00
Logan KS 67646
Herndon Insurance Agency Inc 8/1/11 331 Quincy $75.00
Herndon KS 67739
Hicks-Ronsick Insurance Agency 8/11/11 14201 S Mur-Len - Suite 105 $56.25
Olathe KS 66062-1859
Hier Insurance Services Inc 11/9/11 301 Main $76.00
Maple Hill KS 66507
Highland Insurance Services 8/16/11 310 W Main $75.00
Highland KS 66035
Holmes Insurance Agency 8/24/11 422 N Juliette Ave $75.00
Manhattan KS 66502-5917
Hometown Insurance Svcs Inc 8/2111 126 E Central .{ I
$75.00 Richmond KS 66080
Houtz Agency Inc 9/19/11 709 Broadway $75.00
Marysville KS 66508
Hoxie State Insurance Inc 8/29/11 824 Main $75.00
Hoxie KS 67740
Hundley Insurance Services LLC 11/11/11 1401 Main St $131.25
Atchison KS 66002-2605
ICI 8/6/11 120 W Central $75.00
EI Dorado KS 67042
$863.50
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Ca.h
Check Appropriate Box
Check Loa. Other
Amount of Cash, Check,
Loan or Other Receipt
8/12/11 IMA of Kansas Inc 8200 E 32nd N Wichita KS 67226
$75.00
9/6/11 Insurance Back Office Inc 5200 Bob Billings Pkwy - Ste 301 Lawrence KS 66049-4834
$75.00
9/20/11 Insurance Center 105 S Main Hillsboro KS 67063
$75.00
9/6/11 Insurance Planning Center Inc 220 N Main - Suite 440 Eureka KS 67045
$75.00
11/1/11 Insurance Planning Inc 3006 Broadway Ave Hays KS 67601
$112.50
9/29/11 Insurance Professionals Inc 6606 W Central Bldg #101 Wichita KS 67212-3315
$75.00
9/26/11 Insurance Resources Group Inc 1310 E Park Olathe KS 66061
$75.00
8/22/11 Insurance Services Inc 101 N Main Caldwell KS 67022
12/9/11 Ins Solutions of Kansas LLC 1002 N Broadway St Pittsburg KS 66762
$93.75
8/3/11 Insurance Specialists Group LLC 8415 E 21 St N - Suite 140 Wichita KS 67206-2952
$75.00
8/9/11 Insurance Store/Edwards Agency 437 N Marshall Chapman KS 67431
$75.00
$881.25
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 C....
Check Appropriate Box
Cheek Loan Other
Amount of Cash, Check,
Loan or Other Receipt
8/30/11 • Insurance Works 143 E. Lincoln Lincoln KS 67455
$75.00
12/28/11 Insurica PO Box 25928 Oklahoma City OK 73125
$75.00
7/25/11 Insurors Inc 9415 E Harry - Suite 701 Wichita KS 67207
$75.00
1/7/11 lola Insurance Inc 612 N State St lola KS 66749
$93.75
12/16/11 IPFS Corporation 1055 Broadway - 11 th Floor Kansas City MO 64105-2289
$75.00
11/10/11 Island Insurance Inc PO Box 36 Long Island KS 67647-0036
$75.00
7/29/11 J&D Ins dba Karl A Scholtz Ins 201 N Broadway Lancaster KS 66041
$75.00
10/26/11 J Goodman Insurance Agency 1990 E Santa Fe - Suite 203 Olathe KS 66062
$75.00
12/30/11 JeT Insurance 108 W Main Severy KS 67137
$56.25
12/28/11 John Jaco Inc 820 Main Great Bend KS 67530
$75.00
7/28/11 Jean A Joyce Agency 567 Diamond Springs Rd Denton KS 66017
$75.00
$825.00
Page ~ of 3,3,
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Cuh
Check Appropriate Box
Check Loa. Otber
Amount of Cash, Check,
Loan or Other Receipt
9/6/11 Jelinek Insurance Agency 100 Main St Munden KS 66959-0100
$75.00
7/29/11 Jensen Associates Inc 13 N Main Ellinwood KS 67526
$75.00
8/29/11 Jepson & Associates 307 Sycamore Valley Falls KS 66088
$75.00
9/6/11 Jim Gill Agency Inc 215 W Main Cherryvale KS 67335
$75.00
8/3/11 J-K Agency 1307 E Iron Salina KS 67402
$75.00
8/9/11 Johnson Insurance Agency 901 Chestnut St Frankfort KS 66427
$75.00
9/20/11 Johnson Insurance Agency 324 Liberty Courtland KS 66939
$75.00
8/10/11 Johnston Fiss Insurance 5225 W 75th St - Suite 200 Shawnee Mission KS 66208
$75.00
8/4/11 KASB Workers Camp Fund Inc 1420 SW Arrowhead Rd Topeka KS 66604
$75.00
8/20/11 Kastl-Powell Agency Inc 117 CSt Washington KS 66968
$75.00
8/22/11 Keller-Leopold Insurance Inc 302 Fleming - Suite 1 Garden City KS 67846
$75.00
$825.00
Page~of ~1
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Casb
Check Appropriate Box
Check Lou Other
Amount of Cash, Check,
Loan or Other Receipt
8/16/11 Kellerman Insurance IIlC 101 W 4th St Holton KS 66436
$75.00
8/10/11 Kellner Insurance Services 100 Center Dr Silver Lake KS 66539
$75.00
8/6/11 Kansas Farmers Service Assn 1515 E 30th Hutchinson KS 67502
$75.00
7/28/11 Kidney Insurance Agency Inc 9941 NW Hwy 24 - Suite 2A Silver Lake KS 66539
$75.00
9/14/11 Kimball Insurance Agency Inc 402 N Washington Wellington KS 67152
$75.00
7/25/11 Kinban Inc 616 Colony Ave Kinsley KS 67547
$75.00
9/12/11 Kingman Insurance Agency 120 West B Kingman KS 67068
$75.00
9/6/11 Kingrey-Kellum Agency Inc 1100 Military Ave Baxter Springs KS 66713
$75.00
2/8/11 KMIT/League of Municipalities 300 SW 8th Ave Topeka KS 66603
$75.00
8/5/11 Koger Agency Inc 7154 SW Wattling Ct Topeka KS 66614-4649
$75.00
8/11/11 Kralicek Crop Insurance 406 First St Hunter KS 67452
$75.00
$825.00
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Amount of Name and Address
Occupation & Industry of Check Cash, Check,
Date Appropriate BoxIndividual Giving More
Loan orThan $150of Contributor CRIb Check LoaD Otber
Other Receipt
Kramer Agency Inc 7/25/11 $75.00
Ozawkie KS 66070
KS Restaurant & Hospitality Assn
106 Main
10/17/11 $75.00 Wichita KS 67226
L&W - Andrist Ins Agency LLC
3500 N Rock Rd - Bldg 1300
9/22/11 $75.00 Goodland KS 67735
Labette Insurance Agency 8/1/11
102 E 8th
$75.00 Altamont KS 67330
Lambert Insurance Agency 8/2/11
319 4th St
$75.00 Salina KS 67401-7510
Lind-Merrill Inc
2310 Planet Ave
12/29/11 6045 Martway - Suite 111 $93.75 Shawnee Mission KS 66202
Linn County Ins Agency Inc 11/2/11 332 Market $75.00
LaCygne KS 66040
Linton Insurance Agency 8/9/11 121 N Mill $75.00
Beloit KS 67420
Lonnie Soukup Agency LLC 8/4/11 104 N Douglas Ave $75.00
Ellsworth KS 67439
M&M Insurance 10/31/11 1700 E Douglas $75.00
Wichita KS 67214
MJH Ins and Financial Services 8/11/11 345 N Moonlight $75.00
Gardner KS 66030
$843.75
Page~of 3-1
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 c....
Check Appropriate Box
C"eck Loa. Ot"er
Amount of Cash, Check,
Loan or Other Receipt
10/15/11 M J Kelly Company 4415 E Sunshine Springfield MO 65809
$150.00
9/19/11 Madrigal &Welch 431 S Lulu Wichita KS 67211
$75.00
10/13/11 Marquette Ins & RE Agency 205 N Washington Marquette KS 67464
$75.00
8/26/11 MAX Insurance Agency Inc 8717 W 110th #350 Overland Park KS 66210
$75.00
7/25/11 Maximum Insurance LLC 126 W 8th Horton KS 66439
$75.00
12/28/11 McCune-Robinson Inc dba MRH Insurance - 725 W Cherry Chanute KS 66720
$93.75
12/6/11 McPhail Insurance Services 113 S Main Cimarron KS 67835
$75.00
10/27/11 Med James Inc 8595 College Blvd - Suite 200 Overland Park KS 66210
$75.00
7/25/11 E C Mellick Agency LP 415 State Atwood KS 67730
$75.00
7/17/11 Midland Insurance Group Inc 2969 W 13th St N Wichita KS 67203-6618
$75.00
7/26/11 Midwest Ag Professionals Inc 28236 SW KK Rd - S Hwy 283 Jetmore KS 67854
$75.00
$918.75
Page~of ~~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Check Amount ofOccupation & Industry of Appropriate Box Cash, Check,Individual Giving MoreName and Address
Loan orThan $150Date of Contributor Casb Cbeck Loan Other
Other Receipt
It4 Meadowbrook Insurance Group 10/31/11 11880 College Blvd - Suite 500 $75.00
Overland Park KS 66210
Midwest Professional Insurance 7/25/11 4510 College Blvd $75.00
Leawood KS 66211-1921
Midwest Crop Insurance 8/11/11 611 N 11th $75.00
Seneca KS 66538-1583
Midwest Ins Agency Alliance Inc 10/13/11 6128 Havelock Ave $75.00
Lincoln NE 68507
Midwest Insurance Agency Inc 8/24/11 123 N Tyler - Suite 100 $75.00
Wichita KS 67212-3713
R E Miller Insurance Agency 7/28/11 9415 E Harry #407 $75.00
Wichita KS 67207-5083
Miller &Midyett Real Estate 12/28/11 1045 E 23rd St $56.25
Lawrence KS 66046-5343
Miller Agency Inc 9/19/11 711 Main $50.00
Eudora KS 66025
Miner Brothers Company 9/8/11 101 S Pennsylvania Ave $75.00
Ness City KS 67560
MJH Insurance &Financial 8/11/11 345 N Moonlight $75.00
Gardner KS 66030
$706.25
Page~of 33
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(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 c.... e"eck Lo•• Other
Other Receipt
Morales Insurance Agency 10/31/11 1239 Central Ave $75.00
Kansas City KS 66102
Mullen Insurance Agency LLC 11/9/11 311 Center Ave - Suite A $56.25
Oakley KS 67748-1705
Nason Associates Inc 12/2/11 5700 Broadmoor #905 $75.00
Mission KS 66202
National Ins Producer Registry 10/21/11 2301 McGee St - Suite 800 $75.00
Kansas City MO 641 08
NAU Country 10/20/11 400 NW Curtis $75.00
Topeka KS 66608
Neitzel Insurance Servi,ce LLC 10/13/11 208 W Washington $75.00
St.Francis KS 67756
Ness County Insurance Agency 12/20/11 110 E Sycamore $75.00
Ness City KS 67560
Newkirk Dennis & Buckles Inc 8/3/11 304 N Penn Ave $75.00
Independence KS 67301
Norris Training Systems
.f1/31/11 400 N Woodlawn #111 $75.00 Wichita KS 67208
North American Software Assoc l.f10/13/11 PO Box 192 $75.00 Sauk Centre MN 56378
Northeast Kansas Ins Agency 7/25/11 520 Main St $75.00
Nortonville KS 66060
$806.25
Page~of33
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 C....
Check Appropriate Box
Check Lo.. Other
Amount of Cash, Check,
Loan or Other Receipt
10/24/11 Old RepUblic ~urety Company 1503 42nd St - Suite 100 W Des Moines IA 50305
$75.00
12/19/11 Old United Casualty 8500 Shawnee Mission Pkwy 200 Merriam KS 66202
$75.00
8/29/11 Oliver Insurance Agency Inc 6201 College Blvd #230 Overland Park KS 66211-2338
$75.00
8/26/11 O'Malley Insurance Services Inc 7610 Canterbury Prairie Village KS 66208
$75.00
7/28/11 Palmer Insurance Agency 104 E 2nd Palmer KS 66962
$75.00
12/12/11 Parker Haskins Insurance Inc 1712 Central Dodge City KS 67801-4507
$75.00
9/19/11 Paxico Insurance Agency 117 Newbury Ave Paxico KS 66526
$75.00
8/10/11 Pennway Group PO Box 2923 Kansas City KS 66110
$75.00
12/8/11 Peoples/Commercial Ins Svc LLC 1414 SW Ashworth PI- Suite 201 Topeka KS 66604
$93.75
8/5/11 Personal Service Insurance Inc 211 South St lola KS 66749
$75.00
12/20/11 Philadelphia Insurance Company 20201 E Jackson Dr #400 Independence MO 64057
$75.00
$843.75
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date
8/29/11
8/25/11
8/5/11
8/16/11
8/3/11
7/26/11
11/8/11
8/9/11
10/7/11
12/12/11
Amount of Name and Address
Occupation & Industry of Check Appropriate Box Cash, Check,
of Contributor Individual Giving More
Loan orThan $150 c.... C"eck Loa. Ot"er Other Receipt
Pike Insurance 127 Main $75.00 Minneola KS 67865
Plainville Insurance LLC 218 W Mill $75.00 Plainville KS 67663
PlatinumOne Insurance Agency 4400 W 109th St - Suite 100 $75.00 Overland Park KS 66211-1319
Porter Crop Insurance Inc 9010 1650 Rd $75.00 Fredonia KS 66736
Porter-Spears &Bundy Inc 310 S Main $75.00 Ottawa KS 66067
Power Group Risk Services Inc 12721 Metcalf Ave - Suite 103 $75.00 Overland Park KS 66213
David J Powell &Associates 6872 NE Cole Creek Rd $150.00 EI Dorado KS 67402
Prairie Land Insurance Agency 303 Belleview Ave $75.00 Winona KS 67764
Proguc..er's XL Box'646 $75.00 Salina KS 67402-0646
Professional Ins Consultants 2202 Fairway Dr $75.00 Dodge City KS 67801
$825.00
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Occupation & Industry of Amount ofCheck Name and Address Individual Giving More Appropriate Box Cash, Check,
Date of Contributor Than $150 Loan orc.... e"eck Lo.a Ot"er Other Receipt
Professional Insurance Mgmt Inc 8/1/11 2120 Airport Rd - 2nd Floor $75.00
Wichita KS 67209
Progressive Companies $75.0011/24/11 16011 College Blvd - Suite 215
Lenexa KS 66219
Quivira Insurance Agency 12/13/11 118 S Main $75.00
Stafford KS 67578-1430
Raleigh Insurance Agency Inc $75.007/17/11 340 Main St
Little River KS 67457
The Reilly Company $75.008/2/11 608 Delaware
Leavenworth KS 66048
Renn & Company Inc 7/17/11 209 S Washington $93.75
Wellington KS 67152
Rich & Cartmill-Midwest LLC $75.009/17/11 13025 S Mur-Len Rd - Suite 200
Olathe KS 66062-5440
Riegel Insurance Inc 8/24/11 523 Main St $75.00
Ford KS 67842
Risk Placement Services Inc 12/29/11 7450 W 130th St #200 $75.00
Overland Park KS 66213
Robben Insurance Inc $75.008/25/11 416 Main St
Victoria KS 67671
$768.75
Page~of 23
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Name and Address Date of Contributor
9/9/11 Robert E Miller Insurance Agency 373 W 101st Terr#200 Kansas City MO 64114-4408
12/19/11 Rodgers and Assoc Insurance Inc 383 F St Phillipsburg KS 67661
8/25/11 Romme Agency Inc 1008 E 17th St Hays KS 67601
9/6/11 Rush County Insurance Svcs Inc 821 Main LaCrosse KS 67548
8/9/11 Russell Insurance Agency 1000-3 N Main Lansing KS 66043
7/29/11 SBS Insurance Agency 502 Main Seneca KS 66538
7/26/11 Salina Insurance Services 157 N 9th Salina KS 67401
8/9/11 Samford-Stover Agency 525 N Summit Arkansas City KS 67005-0833
8/9/11 Sanders Agency Inc 100 S Ma.in Pratt KS 67124
11/11/11 The Sanders Agency 302 N Broadway Protection KS 67127-0566
Occupation & Industry of Check Amount of Individual Giving More Appropriate Box Cash, Check,
Than $150 Loan or C.... Check Loa. Other
Other Receipt
" $75.00
$56.25
I $75.00
$75.00
$75.00
I $75.00 I
$75.00.{
$79.00.{
$75.00
$93.75
$750.00
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
7/28/11 .Santa Fe Agricultural Services 1003 W Main Council Grove KS 66846
7/25/11 Saylor Insurance Services Inc 21 Main - Morrill State Bank Sabetha KS 66534
8/29/11 SBAIC dba Howell Insurance 713 Main Ashland KS 67831
7/17/11 SBB Inc dba Biggs Ins Agency 110 W State St - Suite B Phillipsburg KS 67661
9/8/11 Schroeder Insurance Agency 916 N Broadway Pittsburg KS 66762
7/17/11 Scribner Insurance Agency LLC 320 Friend St Cottonwood Falls KS 66845
12/12/11 Select Imaging 19955 W 162nd St Olathe KS 66062
12/19/11 ServiceMaster Catastrophe 11632 Grandview Rd Kansas City MO 64137
11/21/11 AI Shank Insurance Inc 24 W 2nd St Liberal KS 67901
Occupation & Industry of Individual Giving More
Than $150
Check Appropriate Box
Calll Check Lo.. Otlter
Amount of Cash, Check,
Loan or Other Receipt
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$150.00
$75.00
$56.25
$731.25
Page~of ~3>
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Narne of Party Committee or Political Committee)
Date Name and Address
of Contributor
9/14/11 Shermiin Insurance Agency Inc 104 East Ave S Lyons KS 67554
7/26/11 George J Siebers & Co Inc 8500 Shawnee Mission Pkwy 111 Mission KS 66202
7/25/11 Sims Insurance Services Inc 4621 N Maize Rd Maize KS 67101
8/31/11 Smart Insurance Services 300 N Cedar Abilene KS 67410
12/28/11 Snell-Nelson Ins Agency Inc 202 W 8th Ave Ashland KS 67831
10/28/11 Southern Kansas Agency Inc 131 E Randolph Howard KS 67349
8/5/11 Stephen's Insurance Inc 2711 W 6th St - Suite A Lawrence KS 66049-4306
7/26/11 Strong's Insurance Inc - Nashville 201 Main Nashville KS 67112
8/10/11 Strutt's Ins SvclF&M Ins Store 990 S Range - Suite 28 Colby KS 67701
Occupation & Industry of Individual Giving More
Than $150
Check Appropriate Box
C ••b Cbeck Lo.. Otber
Amount of Cash, Check,
Loan or Other Receipt
$75.00
$75.00
$75.00
$75.00
$93.75
$75.00
$75.00
$75.00
$75.00
$693.75
Page~of ~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150 Casla
Check Appropriate Box
Check Loa. Other
Amount of Cash, Check,
Loan or Other Receipt
8/16/11 Stucky Becker Insurance Group 101 N Christian Moundridge KS 67107
.f $75.00
12/7/11 Sullivan Insurance Inc 123 W Central - Suite A Ulysses KS 67880-2519
$75.00
9/20/11 Summit Insurance Group 4041 NE Lakewood Way- Ste 140 Lee's Summit MO 64064-2027
$75.00
12/21/11 Sunflower Insurance Group Inc 2090 S Ohio Salina KS 67401
$75.00
10/1/11 Sunflower Insurance Services Inc 103 W Parallel Clifton KS 66937
$75.00
9/29/11 Surety Support Services Inc 7255 W 98th Terr - Suite 170 Overland Park KS 66212-2200
$75.00
9/23/11 TA Dudley Insurance Agency 600 S Main St Hugoton KS 67951
i.f $75.00
8/26/11 Tallman Insurance Agency 406 W 34th St - Suite 806 Kansas City MO 64111
$75.00
11/8/11 TAS Insurance Group PO Box 1540 Lee's Summit MO 64063
$75.00
11/3/11 Teel Insurance Agency Inc 132 E Maple Columbus KS 66725-0311
$75.00
8/24/11 Thomas McGee LC 920 Main - Suite 1700 Kansas City MO 64105
$75.00
$825.00
Page~of~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
7/28/11 TrustPoint SVC dba TrustPoir'\t Ins 800 N 4th St - Suite 101 Burlington KS 66839-2618
12/29/11 TWI &Dietz Inc 120 N Main St WaKeeney KS 67672
9/22/11 United Agency Inc 726 N Summit Arkansas City KS 67005
11/14/11 United Fire Group 118 2nd Ave SE Cedar Rapids IA 52407
1/4/11 Upland Mutual Insurance Inc 2220 Lacy Dr Junction City KS 66441-7574
8/1/11 Van Hercke Ins Agency Inc 11807 College Blvd Overland Park KS 66210-1314
4/7/11 Wade Patton Insurance 115 E 4th St Hutchinson KS 67504
10/31/11 Walrod Insurance Services 449 Morton Elkhart KS 67950
11/14/11 Wartick Ins Agy dba Wartick Ent 6262 SW Spring Rd EI Dorado KS 67042-9036
Occupation & Industry of Individual Giving More
Than $150
Check Appropriate Box
c.... Cltec:k Lo.. Other
Amount of Cash, Check,
Loan or Other Receipt
$75.00
$56.25
$75.00
$75.00
$75.00
$75.00
$56.25
$75.00
$75.00
$637.50
Page~of ~:s
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Date Name and Address
of Contributor
Occupation & Industry of Individual Giving More
Than $150
Check Appropriate Box
Amount of Cash, Check,
Loan or Other Receipt
Call. Cbeck Loa. Otber
12/13/11 Wathena Insurance 312 St Joseph St Wathena KS 66090
,(,
$93.75
9/15/11 Wayne Wright Insurance Inc 616 W Douglas Wichita KS 67203-1507
$75.00
12/16/11 WEJ Insurance Inc 6606 W Central - Bldg 101 Wichita KS 67212
$75.00
5/5/11 Western Pacific Ins Network Inc 10397 W Centennial Rd #250 Littleton CO 80127
$75.00
1017/11 Western Shelter Insurance Inc 301 E Beatty Johnson KS 67855
$75.00
7/25/11 Whitehead Insurance LLC 5112 E Central Wichita KS 67208
$75.00
1017/11 Wichita Roofing 3821 Bounous Wichita KS 67213-1202
$75.00
7/28/11 Willow Brook Insurance LLC 675 E 253rd St Lyndon KS 66451-9449
$75.00
12/12/11 Wood-Dulohery Insurance Inc 1725 E Washington Ave Parsons KS 67357
$75.00
8/22/11 Z Insurance Group LLC 654 N Woodchuck - Suite A Wichita KS 67212
$75.00
7/8/10 Clay Aurand for Representative Uncashed check #3956
$250.00
$1,018.75
Page~of ~3
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Amount ofOccupation & Industry of Check Cash, Check,Appropriate BoxName and Address Individual Giving More
Loan orDate of Contributor Than $150 c.... Claeck Loa. Other Other Receipt
$0.00
Complete if last page of Schedule A
Total Itemized Receipts for Period $26,168.50
Total Unitemized Contributions ($50 or less) $543.25
Sale of Political Materials (Unitemized) $0.00
Total Contributions When Contributor Not Known $0.00
$26,711.75
Page~of ~
SCHEDULEB IN-KIND CONTRIBUTIONS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Value ofList Occupation & In-KindDescription of In-KindDate Name and Address Industry for Those Giving
ContributionContributionof Contributor an In-Kind of More Than $150
$0.00
Complete if last page of Schedule B
Total Itemized (over $100) In-Kind Contributions $0.00
Total Unitemized ($100 or less) In-Kind Contributions $0.00
$0.00
Page _1_ of_1_
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Insurance Agents Political Action Committee
(Name ofParty Committee or Political Committee)
Date Name and Address
To Whom Expenditure is Made
Purpose of Expenditure
If independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
Amount
03/22/11 Kansas House Democrats 300 SW 10th Avenue, Ste 359-W Topeka, Ks
Donation $500.00
06/24/11 Douthett & Co. 1100 SW Wanamaker Rd, Ste 102 Topeka, KS 66604
CPA fees $2,050.00
06/24/11 United States Treasury 1120 Form taxes
$123.56
06/24/11 Governmental Ethics Commission 109 West 9th Street, Ste 504 Topeka, Ks 66612
Registration $240.00
06/29/11 Emler for Kansas Senate I '151 5h4. ",..'HI" ~ Rei 1-; t"'(:ls \oofll5t 1<s !J> 7 '15'
Donation $500.00
12/21/11 Allen Schmidt for Senate 14648 Hopewell Rd Hays, Ks 67601
Donation $250.00
12/21/11 Mark Taddiken for Senate 2614 Hackberry Rd Clifton, KS 66937
Donation $250.00
12/21/11 Tom Holland for Senate 961 E 1600 Rd Baldwin City, Ks 66006
Donation $250.00
12/21/11 Jeff Longbine for Senate 2801 Lakeridge Rd Emporia, KS 66801
Donation $500.00
12/21/11 Rob Olson for Senate 19050 W 161st St Olathe, Ks 66062
Donation $500.00
12/21/11 Steve Morris 600 Trindle St Hugoton, Ks 67951
Donation $500.00
$5,663.56
Page ---1- of--3
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Insurance Agents Political Action Comrnittee
(Name of Party 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
Jay Emler for Senate Donation 12/21/11 1457 Shawnee Rd $500.00
Lindsborg, Ks 67456
Chris Steineger for Senate 12/21/11 51 S 64th St Donation $300.00
Kansas City, Ks 66111
Paul Davis for Representative Donation 12/21/11 1731 Indiana $500.00
Lawrence, KS 66044
Terrilois Gregory for Rep. Donation 12/21/11 PO Box 105 $500.00
Baldwin City, KS 66006
Richard Proehl for Representative Donation 12/21/11 510 Pine Ridge Rd $500.00
Parsons, KS 67357
Virgil Peck for Representative Donation 12/21/11 PO Box 277 $500.00
Tyro, KS 67364
Mike O'Neal for Representative Donation 12/21/11 8 Windemere Ct $500.00
Hutchinson, KS 67502
Susan Mosier for Representative Donation 12/21/11 3517 Amy Lane $250.00
Manhattan, KS 66503
Arlen Sieg'freid for Rep. Donation 12/21/11 1403 W Prairie Terr $250.00
Olathe, KS 66061
Jene Vickrey for Representative Donation 12/21/11 502 S Countryside Dr $250.00
Louisburg, KS 66053
Vicki Schmidt for Senate Donation 12/21/11 ' :5* 'SW 43rd St $500.00
Topeka, Ks
$4,550.00
Page~of~
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Purpose of Expenditure Date
Name and Address To Whom Expenditure is Made Amount
If independent or in-kind expenditure in excess of $300 is made for a candidate, list candidate name & address
$0.00
Complete if last page of Schedule c
Total Itemized Expenditures This Period
Total Unitemized Expenditures of $50 or less
$10,213.56
$104.63
$10,318.19
Page~of~
SCHEDULED OTHER TRANSACTIONS
Kansas Insurance Agents Political Action Committee
(Name of Party Committee or Political Committee)
Balance at Date Name and Address Nature of Account or Loan Payable Close of
or Loan Receivable Period
$0.00
Complete if last page of Schedule D
$0.00
Page_1_ofi
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