file with secretary of state...

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>





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


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 ~~




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


Than $150


Calh Check Lou Other



$75.00

$75.00

$75.00

$75.00

$75.00

$93.75

$112.50

$75.00

$75.00

$731.25

Page _3_ of ~~




Amount ofOccupation & Industry of Check Appropriate Box Cash, Check,Name and Address Individual Giving More

Date of Contributor Than $150 C.... Check Lou Other


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 ~~




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~



(Narne of Party Committee or Political Committee)


of Contributor


Than $150 Cuh


Cheek Loa. Other



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 ~~





of Contributor


Than $150




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 ~~





of Contributor


Than 5150 Cash


Check Loa. Other



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




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 ~~





of Contributor


Than $150 Cas"


Check Lou Other



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




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 ~~



(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





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





of Contributor


Than $150 C.III


Check Lou Other



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>




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 ~





of Contributor


Than $150 Ca.h


Check Loa. Other



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 ~





of Contributor


Than $150 C....


Cheek Loan Other



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,





of Contributor


Than $150 Cuh


Check Loa. Otber



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





of Contributor


Than $150 Casb


Check Lou Other



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 ~





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





of Contributor


Than $150 c....


C"eck Loa. Ot"er



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 ~~




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


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




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





of Contributor


Than $150 C....


Check Lo.. Other



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 ~




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


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 ~




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


Robben Insurance Inc $75.008/25/11 416 Main St

Victoria KS 67671

$768.75

Page~of 23




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 ~





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


Than $150


Calll Check Lo.. Otlter



$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$150.00

$75.00

$56.25

$731.25

Page~of ~3>





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


Than $150


C ••b Cbeck Lo.. Otber



$75.00

$75.00

$75.00

$75.00

$93.75

$75.00

$75.00

$75.00

$75.00

$693.75

Page~of ~





of Contributor


Than $150 Casla


Check Loa. Other



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~





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


Than $150


c.... Cltec:k Lo.. Other



$75.00

$56.25

$75.00

$75.00

$75.00

$75.00

$56.25

$75.00

$75.00

$637.50

Page~of ~:s





of Contributor


Than $150




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





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



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


(Name ofParty Committee or Political Committee)


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


Kansas Insurance Agents Political Action Comrnittee


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~




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



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

file with secretary of state...

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