of a/political or party committee...
TRANSCRIPT
------------------------------
KANSAS GOVERNMENTAL ETHICS COMNIISSION
~ RECEIPTS AND EXPENDITURES REPORT r---------==\LEO \ OF A/POLITICAL OR PARTY COMMITTEE
\ ,< ~ IG\G January 10,2010Jp,N i
FILE WITH SECRETARY OF STATE EE REVERSE SIDE FOR INSTRUCTIONS
N6U?G\-\ BOI'l ~~~ of SIP-IE.
- c?E.
A. Name ofCoInmittee: _KA_N_A_C_R_N_A_P_A_C _
10437 W 125th TerAddress:
City and Zip Code: _o_v_e_rl_a_n_d_P__a-;-r_k_6_6_21_3 -,------,----- _
This is a (check one): _''_Party Committee ,',~',' Political Committee
B. Check only if appropriate: _'_'_' Amended Filing _,_,'_,' Termination Report
C. Summary (covering the period from January 1, 2009 through December 31, 2009)
1. Cash on hand at beginning of period . $4786.35
2. Total Contributions and Other Receipts (Use Schedule A) .. $6716.65
3. Cash available this period (Add Lines 1 and 2) .. $11503.00
4. Total Expenditures and Other Disbursements (Use Schedule C) .. $10617.42
5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . $985.42
6. In-Kind Contributions (Use Schedule B) .
7. Other Transactions (Use Schedule D) ..
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
1/9/10 Date Signature of Treasurer
failure to file this document or intention ly filing a false document is a class A misdemeanor."
GEe Form Rev, 2001
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANACRNA PAC
(Name of Party Committee or Political Committee)
Check Amount of Appropriate Box Cash, Check,
Loan or Cuh Check Loall Other
Other Receipt
$199.00
t .. $50.00
.f $25.00
.". $75.00
$50.00
.f $50.00
.; $50.00
I $100.00
.f $100.00
./.. $100.00
...f.• $100.00
Occupation & Industry of Name and Address Indiyidual GiYing More
Date of Contributor Than $150
Renee Sinclair Medical 6/8/09 2551 Z Rd CRNA
Webber,KS 66970
Brian Tolefree CRNA 6/8/09 11361284 Rd
Lawrence,KS 66042
Beverly Reeves-Dudley CRNA 6/8/09 8118 Goodman St
Overland Park,KS 66204
Gerald Darger CRNA 6/8/09 603 N 9th St
Klowa,KS 67070
Aaron Petersen CRNA 6/8/09 14661 Travis St,Apt 23202
Overland Park, KS 66223
John Canady CRNA 6/8/09 3708 Persimmon Circle
Manhatlan,KS 66503
Megan Robertson CRNA 6/8/09 3610 Govemeour Cir
Wichita, KS 67226
Lori Harris CRNA 6/8/09 3207 Northwood Ct
Newton,KS 67114
Jeff Herman CRNA 6/8/09 905 Biltmore Ct
Lawrence, KS 66049
Fara Needham CRNA 6/8/09 7309 E Orme St
Wichita,KS 67207
Sana Slaba CRNA 6/8/09 2409 Diane Dr
Dodge City,KS 67801
$899.00
Page _1_ of__
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANACRNA PAC
(Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check,
Date of Contributor Than $150 Loan or Cub Cb.d, Loan Other
Other Receipt
Kay Clark CRNA 6/8/09 8930 Peppertree Cir $100.00
Wichita.KS 67226
Keith McDaniel CRNA 6/8/09 612 Central St #305 $50.00
Kansas City,MO 64105
Marian Lindberg CRNA
~6/8/09 506 E 13th $35.00 Ellis,KS 67637
Rebecca Lucke CRNA
I6/8/09 2301 Pepper Ridge Circle $25.00 Wichita.KS 67205
Sonya Jurgens CRNA 6/8/09 1735 SW Stutley Rd .f $100.00
Topeka,KS 66615
Patricia Nigro CRNA ...{6/8/09 9711 Catalina St $100.00
Overland Park,KS 66207
Nathan Buerge CRNA 6/8/09 10815 W 145th Ter .f $100.00 ..
O(verland Park, KS 66221
Marsha Stineman CRNA 6/8/09 557 Parkway $100.00
Pratt,ks 67124
Nancy Whitson CRNA .;6/8/09 7542 SW Arthurs $100.00 Topeka,KS 66610
Tom McKibban CRNA 6/8/09 3650 N Main St .~ $100.00
EIDorado,KS 67042
Jennifer Smith CRNA 6/8/09 3906 Prairie Hills DR $50.00
Hutchinson,KS 67502
$860.00
Page _2_ of__
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check,
Date of Contributor Than $150 Loan or C••h Check Lo.u Othu
Other Receipt
Todd Decuir CRNA 6/8/09 413 N Olivia Ave $100.00
Lawrence,KS 66049
William Mathia CRNA .. ~.
6/8/09 17278 Eisenhower Rd $100.00 Leavenworth,KS 66048
R Martin CRNA 6/8/09 PO Box 1046 $100.00
Meade,KS 67864
Lynn Dunford Medical 6/8/09 PO Box 875 CRNA $250.00
Garden City,KS 67846
Tom Troy Medical 6/8/09 PO Box 875 CRNA $250.00
GardenCity,KS 67846
Ken Moburg Medical 6/8/09 16225 Gilman Rd CRNA $200.00
Leavenworth,KS 66048
Jerry Thomas CRNA 6/8/09 PO Box 308 .f $50.00..
Concordia,KS 66901
Susan Jones CRNA 6/8/09 24112 W 79th Ter $40.00
Lenexa,KS 66227
Robert Miller Medical .;6/8/09 617 N Chestnut CRNA $200.00 Beloit,KS 67420
Son Tran Medical .;6/8/09 522 Autumn Glen Ct CRNA $300.00 Newton,KS 67114
..
Alva Bowyer Medical 6/8/09 PO Box 1647 CRNA .; $200.00
Junction City,KS 66441
$1,790.00
Page_~oC__
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANA CRNA PAC
(Name of Party Committee or Political Committee) ,
Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check,
Date of Contributor Than $150 Loan or C..h Check LoaD. Other
Other Receipt
Tim Flynn CRNA .;6/8/09 12871 Westgate $100.00 Overland Park,KS 66213
Ronda Brammer CRNA .;6/8/09 1913 N Frederic $100.00 Wichita,KS 67206
Florence McAmis CRNA
.f6/8/09 20501 Crickett Ln $50.00 Lenexa,KS 66220
Jackie Urban CRNA
.f6/8/09 1984 Pecan Valley Ct $25.00 Lawrence,KS 66047
Lisa Payne CRNA 6/8/09 2406 SW Romar Rd $25.00
Topeka,KS 66614
Sherry Hugi CRNA 6/8/09 7630 Forest Park Dr .f $50.00
Lenexa,KS 66217
Tom Miller CRNA
.f6/8/09 1109 Barberry Dr Medical $200.00 Hutchinson,KS 67502
Kendra James CRNA
16/8/09 3700 Manly Rd $100.00 Goddard,KS 67052
Genevieve Crofoot CRNA .;6/8/09 13062 W Plum Rd $50.00 Peoria,AZ 85383
Erin Jacob CRNA 6/8/09 1676 Saint Mary St Medical $200.00
Catherine,KS 67627
Jim Manning CRNA 6/8/09 2012 Walnut $100.00
Hays,KS 67601
$1,000.00
Page _4_ of__
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Check Amount of Appropriate Box Cash, Check,
Loan or Cash Check L08n Other
Other Receipt
./ $100.00
I .. $100.00
./ $100.00
$100.00
$100.00
./ $100.00
.f $100.00
.f $100.00
.f $500.00
I .. $50.00
$50.00
Occupation & Industry of Name and Address Individual GiYing More
Date of Contributor Than $150
Donna Nyght CRNA 6/8/09 13863 W 57th Ter
Shawnee,KS 66216
Albert Giambrone CRNA 6/8/09 912 Overhill Rd
Manhatlan,KS 66503
Sharon Nieman CRNA 6/8/09 2641 S 218th W
Goddard,KS 67052
Christine Flaming CRNA 6/8/09 4217 SE 69th St.
Berryton,KS 66409
Denise Patterson CRNA 6/8/09 2287 Highway K25
Colby,KS 67701
Duane Smith CRNA 6/8/09 6000 Story Brook DR
Manhatlan,KS 66503
Donald Pekrul CRNA 6/8/09 5818 NW Glenwood Dr
Topeka,KS 66617
Diana Daigle CRNA 6/8/09 1313 S Aldrich Dr
Andover,KS 67002
Greg Seiler Medical 6/8/09 1412 Kingsbury CRNA
Garden City,KS 67846
Kurt Englert CRNA 6/8/09 4518 W 53rd Ter
Roeland Park,KS 66205
Debbie Mocella CRNA 6/8/09 12112 Ballentine
Overland Park,KS 66213
$1,400.00
Page _5_ of__
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Date
6/8/09
9/3/09
9/4/09
9/4/09
4/24/09
4/23/09
3/15/09
.. 3/2/09
11/20/09
Name and Address of Contributor
Brian Tackitt 7995 W River Rd Holcombe,KS 67851
Bank of America
Nicholas Muller 19624 W 98th St Lenexa,KS 66220
Ronald Boyson PO Box 378 708 Oak St Scott City,KS 67871
Rachel Edgerton 9507 N Askew Ave Kansas City,MO 64156
Paul Hertel 5041 Mund RD Shawnee,KS 66216
Anne Jack 1330 N Robin CT Andover,KS 67002
Donna Vierthaler 2866 Wilderness CT Wichita,KS 67226
Rebecca Kramer 1309 Hickory Creek ct Wichita,KS 67235
Occupation & Industry of IndiYidual GiYing More
Than $150
CRNA
Returned Check Printing Fee
CRNA
CRNA
CRNA
CRNA
CRNA
CRNA
CRNA Medical
Cash
Check Appropriate Box
Check Loan Other
.f
.".. .
./
.f
I:
.;
Amount of Cash, Check,
Loan or Other Receipt
$10.00
$119.00
$50.00
$50.00
$48.25
$96.80
$96.80
$96.80
$200.00
$767.65
Page _~ of__·_
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Occupation & Industry of Check Amount of Name and Address. Individual Giving More Appropriate Box Cash, Check,
Date of Contributor Than $150 Cash Cbeck Lo.u Otber
Loan or Other Receipt
$0.00
Complete if last page of Schedule A
Total Itemized Receipts for Period $6,716.65
Total Unitemized Contributions ($50 or less)
Sale of Political Materials (Unitemized)
Total Contributions When Contributor Not Known
$6,716.65
.
Page -.!...__ of _
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Date Name and Address
To Whom Expenditure is Made
. 02113/09 KANA 2866 Wildemess Ct
. Wichita KS 67226
06/10109 Bank of America
06/18/09 Bank of America
06/18/09 Gov Ethics Comm Topeka, KS
09/10109 Bank of America
12109/09 John Grange 1115 Rim Rock RD EIDorado,KS 67042
12109/09 Peggy Mast 765 Road 110 Emporia,KS 66801
12109/09 David Crum 2903 Lakeshore DR Augusta,KS 67010
12109/09 Ed Trimmer 1402 E 9th Ave Winfield,KS 67156
12109/09 Kasha Ketley
.. Box 1111 Valley View Arkansas City,KS 67005
12109/09 Gail Finney 1754 N Madison Ave Wichita,KS 67214
Purpose of Expenditure
.Printing PAC Envelopes
. Returned Check and Bank Fee
Check Printing Fee
Fee
Check Printing Fee
Campaign Contribution
Campaign Contribution
Campaign Contribution
Campaign Contribution
.. Campaign Contribution
Campaign Contribution
Amount
$167.42
$56.00
$119.00
$240.00
$23.00
$150.00
$250.00
$200.00
$200.00
$150.00
$150.00
$1,705.42
1page__ of
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Date Name and Address
To Whom Expenditure is Made Purpose of Expenditure Amount
12109/09 Jim Ward 3100 E Clark Wichita, KS 67211
Campaign Contribution $200.00
12109/09 Brenda Landwehr 2837 N Edwards St Wichita,KS 67204
Campaign Contribution $250.00
12109/09 Phil Hermanson 5338 S Mosley Wichita,KS 67216
Campaign Contribution $200.00
12109/09 Geraldine Flaharty 1816 E Femwood Wichita,KS 67216
Campaign Contribution $200.00
12109/09 Aaron Jack 1330 N Robin Ct Andover,KS 67002
Campaign Contribution $250.00
12109/09 Michael R O'Neal 8 Windemere Ct Hutchinson.KS 67502
Campaign Contribution $250.00
12109/09 Clay Aurand 213630 Rd Courtland,KS 66939 0
Campaign Contribution $200.00
12109/09 Bob Bethell 104 E 3rd Box 186 Alden,KS 67512
Campaign Contribution $150.00
12109/09 Melvin Neufeld 740515 Rd Ingalls,KS 67853
Campaign Contribution $150.00
12109/09 Pat George 3007 Westview Dodge City.KS 67801
Campaign Contribution $200.00
12109/09 James Morrison #3 Cottonwood Dr Box366 Colby,KS 67701
Campaign Contribution $200.00
$2,250.00
Page _._2_ of_·_
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
AmountPurpose of ExpenditureName and Address Date To Whom Expenditure is Made
Campaign·ContributionDavid Haley $250.00. 12/09/09· 936 Cleveland Ave
KansasCity,KS 66101
Chris Steineger ·Campaign Contribution $250.0012109/09 51 S 64th St
Kansas City,KS 66111
Thomas COwens Campaign Contribution. $250.007804 W1 OOthSt12/09/09
Overland Park,KS66212 a Mary Pilcher Cook Campaign Contribution·
$250.0013910 W58th PI12/09/09 Shawnee,KS 66216·
Derek Schmidt Campaign Contribution $250.00 .Box 804 12109/09
Independence,KS 67301
. Bill·Otto Campaign Contribution $150.0012109/09· 1029th
LeRoy;KS 66857
Virgil Peck,Jr Campaign··Contribution $150.0012/09/09 Box 277
Tyro,KS 67364
Jeff King Campaign Contribution 12/09/09 $200.001212 N 2nd St
Independence,KS.67301
Arlen Sigfried Campaign Contribution· 12109/09 $250.001403 W Prairie Ter
Olathe;KS 66061
Jill Quigley Campaign Contribution . 12/09/09 $200.0013112 SW 84th St
Lenexa,KS 66215
Cynthia Neighbor Campaign Contribution 12109/09 $150.0010405 W 52nd Ter
Shawnee,KS 66203
$2,350.00
3page__ of
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
KANA CRNA PAC
(Name of Party Committee or Political Committee)
Date Name and Address
To WhoniExpenditure is Made Purpose of Expenditure. Amount·
12/09/09 Dolores Furtado 10104 Hemlock Dr Overland Park,KS 66212
. Campaign Contribution $200.00
.' 12109/09 . Mike Slattery
5015 Reeds Rd Box 1171 Mission,KS 66222
Campaign Contribution $150.00 .
12109/09 Ray Merrick 6874 W 164th Ter Stilwell,KS 66085
Campaign Contribution $250.00
12109/09 Mike Kiegerl 2350 Golf Course Rd Olathe,KS 66061
Campaign Contribution $150.00
12109/09 Barbara Ballard 1532 A1vamar Lawrence,KS 66047
Campaign Contribution $150.00
12109/09 Scott Schwab 14953 W 140th Ter Olathe,KS 66061
Campaign Contribution $200.00
12109/09 Lana Gordon 5820 SW 27th St Topeka,KS 66614
Campaign Contribution $200.00
12109/09 Annie Tietz 329 SW Yorkshire Rd Topeka,KS 66606
Campaign Contribution $200.00
12109/09 Don Hill 1720 Luther Emporia,KS 66801
Campaign Contribution $200.00
12109/09 Gerald T Henry 3515 Neosho Rd Cummings,KS 66016
Campaign Contribution $150.00
12/09/09 Tom Hawk 3115 Harahey Ridge Manhattan,KS 66502
Campaign Contribution $150.00
$2,000.00
Page _4_ of__
SCHEDULEC EXPENDITURES-AND OTHER DISBURSEMENTS
KANACRNA-PAC .
(Name ofParty Committee or Political Committee)
-Date Name and Address .
-To Whom Expenditure is Made Purpose of Expenditure Amount.
12109/09Marc Rhoades 1006 Lazy Creek DR Newton;KS67114
Campaign Contribution $150.00
.. 12109/09 -Clark- Shultz 707 Washington Cir _Lindsborg,KS 67456
·-Campaign Conttibution $200,Ocr ..
-12109/09 Don Schroeder 13114th Ave Inman,KS67546
Campaign Contribution $200.00
12109/09 Vicki Schmidt -5906 SW 43rd Ct Topeka,KS66610
Campaign Contribution _ $250.00
12109/09 Roger Reitz 1332 Sharingbrook Box 1308 Manhattan,KS 66506
Campaign Contribution $250.00
12/09/09 Pete Brungardt 522 Fairdale Rd Salina;KS-67401
Campaign Gontribution $250.00 .
12109/09Ruth Teichman 434- E01d-Hywy 50 Stafford,KS 67578
Campaign Contribution $250.00 -
12109/09 Terry Bruce 401 E Sherman Hutchinson,KS 67501
·Campaign Contribution $250.00
1-2109/09 Jeff Colyer 13825Horton OverlandPark,KS 66223
Campaign Contribution $250.00
12109/09 Stephen R Morris600Trindle St Hugoton,KS 67951
·Campaign Contribution $250.00
-$2;300.00
5 5Page -__of_._..
SCHEDULEC EXPENDITURESANDOTHER·DISBURSEMENTS
KANACRNA PAC
(Name of party Corrunittee or Political Committee)
Amount.Pur:pose of E:xpenditureName and Address To Whom Expenditure is .Made.
Date
$0.00
Complete if last page of Schedule-c
.Total Itemized Expenditures This Period-
TotalUnitemized ExpenditUres of$50or less
$10,605.42
.Page __ of__