employers mutual casualty company pac6033scanned

8/7/2019 Employers Mutual Casualty Company PAC__6033__scanned

1/8

0 1/ 0 8/ 2 00 7 1 3 : 0 0 FAX 5152802754

FOR I NSTRUCTI ONS, SEEBACK OF FORMDI SCLOSURE SUMMARYPAGE

COMMI TTEE NAME ( Mu s t b e s ame as o n St a t eme n t o f O r g a n i z a t i o n )Emp l o y e r s Mu t u a l C a s u a l t y Co . P o l i t i c a l Ac t i o n Comm . f o r R e s p o n s i b l e St at e Gov t .I MPORTANT : I n d i c a t e b y # t y p e o f c ommi t t e e y o u a r e r e p o r t i n g f o r : 12J( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r Re t e n t i o n Ca n d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) Co u nt y C e n t r a l Commi t t e e ( 5 ) Co u n t yCa

_ (n d i d a n d i d a t e ( 7 ) S c ho o l B o ar d o r Ot h e rP o l i t i c a l Su b d i v i s i o n Candi 7 t i u n l y R M 1 0 ) S c h o o l B o ar d o r Ot h e r P o l i t i c a lS u b d i v i s i o n PAC o

CANDI DATECOMMCa n d i d a t e Name

O f f i c e S o u g h t

ONLYI 2 0 0 7 P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

D i s t r i c t ( i f Se n a t e o r H o u s e )

L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l an d c r i m i n a l p e n a l t i e s . P u r s u a n t t o I o wa Code s e c t i o n 68B. 3 2 A( 7 )t h e c a n d i d a t e , f o r a c a nd i d a t e ' s c ommi t t e e , an d t h e c h a i r p e r s o n , f o r any o t h e r t y p e o f c ommi t t e e , i s t h ei n d i v i d u a l r e s go %i b l e f o r f i l i n g t i m e l y a nd , a gu r a t e r e p o r t s .

I AM F I L I NG A

SI GNATUREOF PERSON F I L I NG REPORT TELEPHONE

J a n u a r y 1 9 , 2 0 0 7

EMC I NSURANCE EXECUTI VE

( r e p o r t d a t e ) I n d i c a t e b y #CHECK I F AMENDMENT TOREPORT DATED

0Ch e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t an d a t t a c h N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Yo u mus t c o n t i n u e t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d . )

REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .

STATEMENT OF CASH ON HAND

5 1 5- 3 4 5 - 2 95 0

CASH ON HAND a t t h e b e gi n ni n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u nd s h e l d b y t h ec o mmi t t e e . T h i s amou nt MUST b e t h e s ame as t h e c a s h o n h a n d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d o r mus t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 9 , 0 4 3 . 1 7ADDTOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : Cash C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A) ( ' a l s o s e e i n - k i n d b e l o w) . . . . . . . , . . . . . . . . . . . . .Sc h e d u l e F: L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( S ch e d ul e H ao o l i e s t o Ca nd i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . $ 9 , 9 3 5 . 0 5

SUBTRACT TOTALMONEY SPENT T HI S PERI ODSc h e d u l e B : Ex p en d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B) ( " a l s o s e e d eb t s an d l o an s b el o w) . . . . . . , . , . . . , . . , . . 1 , 2 0 0 . 0 0Sc h e d u l e F : L o a n Re p a yme n t s t o t a l A t t a c h Sc h e d u l e F 0 . 0 0

FORMDR- 2 DI SCLOSURE( Re v . 1 2 1 2 005 ) REPORTF o r O f f i c e Us e On l yComm. #L o g g e4S c a n n e dCompu t e rAu d i t e d

F i l e w i t h :I o wa E t h i c s an d Campa i gnDi s c l o s u r e B o ar d5 1 0 E . 1 2 " ' , St e . 1 ADes Mo i n e s , I o wa 5 0 3 1 9Fa x : 5 1 5- 2 8 1 - 3 7 0 1

L o c a l Commi t t e e s , e n t e r Da t e o f E l e c t i o n

Coun t y l i L o c a l Commi t t e e s , e n t e r Coun t y i nwh i c h E l e c t i o n i s h e l d

8 9 1 . 8 80 . 0 00 . 0 0

CASH ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b al a nc e mus t 8 , 7 3 5 . 0 5b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

l - - Y-D7DATE SI GNED

' " ` UNP AI D B I L LS ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . $ 0 . 0 0' 1 N K I ND CONTRI BUTI ONS ( F r o mSc h e d u l e E - A t t a c h Sc h e d u l e E) . . . . . . . . , . . , . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . . . . . . . . . . . . . . . . . . $ 0 . 0 0" " OUTSTANDI NG LOANS ( F r o mSc h e d ul e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0CONSULTANT BREAKDOWN ( Sc h e d ul e GAt t a ch e d ? ) -YES , - NOCANDI DATE COMMI TTEES ONLY :VALUEOF CAMPAI GN PROPERTY( Fr om Sc h e d ul e H - A t t a c h Sc h e d u l e H)STATE COMMI TTEES : Submi t a r e c o n c i l e d c amp a i g n a c c o u n t b a n k s t a t eme n t i n J a n u ar y o f e a c h y e a r .

0 03


2/8

0 1 / 0 8 / 2 00 7 1 3 : 0 1 FAX 5 1 5 2 8 0 2 7 5 4 EMC I NSURANCE EXECUTI VE ?004

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS " " MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t eme n t o f O r g a n i z a t i o n )Emp l o y e r s Mu t u a l Ca s u al t y Co . P o l i t i c a l Ac t i o n Comm . f o r Re s po n s i b l e S t a t e Go v l

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA TI ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.NOTE : ANYPERSON, OTHER THAN AN I N DI V I D UA L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOURCAMPAI GN MAYHAVE F I L I N GRESPONSI B I L I T I ES ANDSHOULD I MMEDI ATELY CONTACT THE BOARD.CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o m m e r c i a l p ur p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y 6m a r r i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Page 1 o ff a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n , ( f o r S c h e d u l eA)

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSCJ CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAM ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DDYR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME1 0/ 6 , _ p g #1 1/ 3 , Ro n He r ma n $ 1 0 . 0 01 1/ 1 7/ 06

CK# 1209 Be n t wo o d CtA l t o o n a , I A 4 x $ 2 . 5 0 =D#Gr e g C h r i s t i a n s o n 1 3 . 0 0CK# 7 8 1 9 Hwy 5 5 2NBa t e 5 4 x 3 . 2 5 =I D# J e r r y Ri c h ar d s 2 0 . 0 0CK# 1 3 0 1 Me r l e Ha y RdDe s Mo i n e s , I A 4 x $ 5 . 0 0 =I D#Hea t h e r Bo u s t e ad 1 3 . 0 0CK# 7 6 1 8 Ma d i s o n Av emax r r Z D i x i FD# J i m Daws o n 1 2 . 0 0CK# 9 01 7 Ri d ge v i e w DrJ o hn s t o n I A 5 0 1 3 1 4 x $ 3 . 0 0 =D# Mar t i n Reed 20 . 0 0

CK# 7 3 7 E Wa l n u t , #2 9E l k h a r t I A 5007 3 4 x $ 5 . 0 0 =I D# J o e l Os w al d 1 3 . 0 0CK# 4 5 6 5 Par k v i ew DrP l e a s a n t H i l l I A 50 3 27 4 x $ 3 . 2 5 =I D# Mi k e Ha n b a c k 1 5 . 0 0CK# 4 2 1 2 AdamsDe s Mo i n e s , I A 5 0 3 1 0 4 x $ 3 . 7 5 =I D# Bo b Mo r l a n 4 0 . 0 0CK# 3 4 0 4 Wa k u n d a CtDe s Mo i n e s , 1 1 A 5 0 3 2 1 4 x $ 1 0 . 0 0 =I D# Dea na C l a r k 1 3 . 0 0CK# 2 0 2 S Ma i n

Mon r o e , I A 5 0 1 7 0 4 x $ 3 . 2 5 =


3/8

0 1/ 0 8/ 2 00 7 1 3 : 0 1 FAX 5152802754 EMC I NSURANCE EXECUTI VE Z005

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME( Mu s t b e sa me a s o n St a t e me n t o f Or g a n i z a t i o n )Emp l o y e r s Mu t u a l Cas u a l t y Co . P o l i t i c a l Ac t i o n Comm. f o r Re s po n s i b l e St at e Gov l

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TTEE) , L I ST THE PAC I DENTI F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANYPERSON, OTHER THAN AN I NDI V I DUAL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I NGRESPONSI B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD.CAUTI ON : Se c t i o n 89B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o nt r i b u t i o n s o r f o r a n yc o mme r c i a l p ur p os e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l as t p a ge o f t h i s s c h e d u l e )

$ 1 3 3 . 6 4

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p mus t b a s h o w n t o t h e - r 1 1 e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y.m a r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Page 2 o f 6f a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l eA)

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBS SANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOME1 0/ 6 , 1 0 / f 4 v , #1 1 / 3, Di c k Ho f f ma nn $ 1 2 . 0 01 1/ 1 7 / 0 6 CK# 717 S 2 5 t h CtWe s t Des Mo i n e s , I A 5 0 2 6 5 4 x $ 3 . 0 0 =I D# Sea n P e l l e t i e r 1 3 . 0 0CK# 1 3 9 2 7 Br y n Mawr Dr

Ur b an d a l e I A 3 2 4 3 . 2 5 =I D#

Ke n Cumpst on 1 2 . 0 0CK# 190 0NW152nd StC l i v e I A 50325 4 x $ 3 . 0 0 =I D# Dave Hi x e n b a u g h 1 3 . 8 4CK# 4 9 0 3 Lake wood Dr

I D#St e ph an i e Kenne dy 1 3 . 0 8CK# 3 0 0 0 Gr a n d , Ap t . 416De s Mo i n e s I A 50312 4 x $ 3 . 2 7=I D# Mi k e Bl o omb ur g 6. 0 0CK# 4 6 3 8 El mWes t De s Mo i ne s I A 50265 4 x $ 1 . 5 0 =Ro n Ha l l e n b e c k 3 0 . 0 0CK# 5 8 8 0 Br e n t woo dJ o hn s t o n I A 4 x $ 7 . 5 0 =

I D#Me l i s s a Hansen 6 . 0 0CK# 330 NE Ca r e f r e e LnWau k e e , I A 50263 4 x $ 1 . 5 0 =

I D#Al l a n Pa u l e y 7 . 7 2CK# 407 Har t f o r dDc s Mo i n e s , I A 4 x $ 1, 9 3=

I D# J o h n Power 2 0 . 0 0CK# 217 El mSt o r y C i t y , I A 5 0 2 48 4 x $ 5 . 0 0 =


4/8

0 1 / 0 8 / 2 00 7 1 3 : 0 1 FAX 5 1 5 2 8 0 2 7 5 4 EMC I NSURANCE EXECUTI VE 0 ] 0 06


( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t b e sa me a s o n St a t e me n t o f Or g an i z at i o n )Emp l o y e r s Mu t u a l Cas u a l t y Co . P o l i t i c a l Ac t i o n Comm . f o r Re s po n s i b l e S t a t e Go v l

SCHEDULEA MONETARY( Re v . 0 7 1 0 3 ) I RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF 1 0 NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHER THAN AN I N D I V I D UA L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOURCAMPAI GN MAY HAVE F I L I N GRESPONSI B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD.CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTAL$

TOTAL ( i f l a s t page of t h i s s c h e d ul e )1 7 9 . 4 0

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e , R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) , I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Page 3 o f _6f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A )

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MMI DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME1 0 / 6 , 1 0 / J D# Ge or i a Rhoades $ 4 4 . 0 01 1 / 3 , CK# 3 6 3 3 C o r n e l l11 / 17 / 06 Des Mo i n e s , I A 5 0 3 1 3 4 x $ 1 1 . 0 0 =I D#

" Robe r t Gr e e d y 1 2 . 0 0CK# 1104 Cl ar ke s 5 0 4 x $ 3 . 0 0 =

I D# Na t h a n Habben 1 6 . 0 0CK# 2 10 S P r a i r i e Vi e w Dr . , Ap t . 8 3 7Wes t De s Mo i n e s I A 4 x $ 4 . 0 0 =I D# S c o t t He r r e n 1 3 . 0 0CK# 1155 S Wi l l o w C i r c l e1 A 5 0 2 6 6 4x , " 95=I D# Mi k e McGi nn 1 0 . 0 0CK# 2 6 2 1 NWHe r i t a g e Av e

A n k e n 1 A 50021 4 x $ 2 . 5 0 =I D# R u s s e l l Gr e e n wo o d 1 5 . 4 0CK# 1 42 3 Sk y l an e DrNo r wa l k , I A 502 11 4 x $ 3 . 8 5 =I D# T o d d Pr i d eau x 2 0 . 0 0CK# 3 1 1 9 5 6t h S tDe s Mo i n e s I A 5 0 3 1 0 4 x $ 5 . 0 _ 0 =I D# Mo n t e B a l l 2 0 . 0 0CK# 3 04 4 1s t S tDes Mo i n e s , I A 4 x $ 5 . 0 0 =I D# He r b S u f f e l 1 5 . 0 0CK# 9 9 0 3 r dWauk ee I A 5026 3 4 x $ 3 . 7 5 =I D# C a r o l e Ha l l e n be c k 1 4 . 0 0CK# 5 8 8 0 Br e n t wo o dJ o h n s t o n , I A 4 x $ 3 . 5 0 =


5/8

0 1/ 0 8/ 2 00 7 1 3 : 0 2 FAX 5 15 28 02 75 4 EMC I NSURANCE EXECUTI VE Z007

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME( Mu s t b e s ame a s o n S t a t e me n t o f Or g an i z a t i o n)Emp l o y e r s Mu t u a l C a s u a l t y Co . P o l i t i c a l A c t i o n Comm. f o r Re sp o ns i b l e S t a t e Gov t

SCHEDULEA MONETARY( R e v , 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DAT ES NOT E : I F A CONTR I BUT I ON I S RECE I VED FROMA STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) , L I S T T HE PAC I DENT I F I CAT I ONNUMBER ANDTHE PAC CHECKNUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARDNOTE : ANY PERSON, OTHER THAN AN I NDI V I DUAL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I NGR ESPONS I B I L I T I E S ANDSHOULD I MMEDI ATELY CONTACT THE BOARD .CAUT I ON : S e c t i o n 68B. 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o mm e r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n o Page 4 o f _6f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n , ( f o r S c h e d u l e A )

SUB - TOTAL $ 1 3 5 . 0 8TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )

DATE AC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELAT I ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND( MM/ DD[ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S E RNUMBER I NCOME

1 0/ 6 , 1 0 / Oq #1 1 / 3, Beech T u r n e r $ 1 3 . 0 011/ 17/ 06 CK# 1 9 0 4 7 5 t h S t r e e tDes Moi nes , 1 A 5 0 3 2 2 4 x $ 3 . 2 5 =I D#

Sh a r o n Ge nt s c h 5 . 0 0" CK# 40 8 L a c o n aDe e I A 5 0 3 1 4 . 2 5 =D#" Ka t h y K nu t s e n 1 0 . 0 0CK# 2 50 0 As h wo r t h RdWes t De s Mo i n es I A 5 0 2 6 5 4 x $ 2 . 5 0 =" I D# J o e Bu r k l e 1 6 . 0 0CK# 14421 B r y n MawrI D#

C h u c k Her r o l d 2 0 . 0 0CK# 4 7 1 6 6 7 t h S tUr b a nd a l e I A 5 0 3 2 2 4x$5 . 0 0=

I D# Ro n P a i n e 1 6 . 0 0CK# 1 0 5 7 7 E l mc r c s t DrWest De s Mo i n es 1 A 5 0 3 2 5 4 x $ 4 . 0 0 =I D# A l i s o n Ca t e 4 . 0 0CK# 6 7 0 9 Comp t o n Ct

J o h n s t o n I A 5 0 1 3 1 4 x $ 1 . 0 0 =I D# - _Ra y Da v i s 1 3 . 0 8CK# 1 2 9 2 6 T i mber l i n e DrUr b a nd a l e , I A 5 0 3 2 3 4 x $ 3 . 2 7 =

I D# Kev i n Ho v i c k 1 4 . 0 0CK# 1 3 5 6 0 L a k e Sh o r e DrC l i v e , I A 5 0 3 2 5 4 x $ 3 . 5 0 =I D# Ro n J e a n 2 4 . 0 0CK# 2 2 14 R i d g e wo o d DrA l t o o n a , I A 4x$6 . 0 0=


6/8

0 1 / 0 8 / 2 00 7 1 3 : 0 2 F AX 5 1 52 8 02 7 54 EMC I NSURANCE EXECUTI VE 0 ] 0 08

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t eme n t o f O r g a n i z a t i o n )Emp l o y e r s Mu t u a l Ca s u a l t y Co . P o l i t i c a l Ac t i o n Comm . f o r Re s po n s i b l e S t a t e Go v l

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA TI ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHER THAN AN I N D I V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONSI B I L I T I ES ANDSHOULD I MMEDI ATELY CONTACT THE BOARD .CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o m m e r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c ommi t t e es .

SUB- TOTAL 175 . 6 0TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e 5 o f _6f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n . ( f o r Sc h e d u l e A )

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

DATE PA I DNUMER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUND( MMI DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

10 / 6 1 0 / aD#,1 1/ 3, Br u c e Ke l l e y $ 24 . 6 01 1 / 1 7/ 0 6 CK# 1 4 Gl en v i ew DrDes Mo i n e s , I A 50 3 12 4 x $ 6 . 1 5 =I D#

Wi l l i amMu r r a y 1 3 . 0 0" CK# 1 7 7 0 Bi r c h wo od C i r c l eWau ke e I 5 0 2 6 3 4 . 2 5 =I D# S a r a h Ba r t h o l o me w 1 8 . 0 0CK# 2007 3 9 t h S tDe s Mo i n e s , I A 5 0 3 1 0 4 x $ 4 . 5 0 =I D#J e r r y Mc Cl e l l a n d 1 4 . 0 0CK# 9 6 0 9 T an g l e wo o d Dr 4I D# De n n i s C h r i s t y 1 3 . 0 0CK# 1 8 0 1 NW8 1 s t S tC l i v e I A 5 0 3 2 5 4 x $ 3 . 2 5 =I D# J o h n S c h u ma c h e r 1 3 . 0 0CK# 4 7 1 8 9 3 r d StUr b a n da l e , I A 5 0 3 2 2 4 x $ 3 . 2 5 =I D# Bo b Ne s w o l d 2 6 . 0 0CK# 1 8 7 5 2 n d S tWes t De s Mo i n e s I A 5 0 2 6 5 4 x $ 6 . 5 0 =I D# J i m F o n t a n i n i 2 8 . 0 0CK# 9 29 4 3 r d S tWes t De s Mo i n e s , I A 5 0 2 6 5 4 x $ 7 . 0 0 =I D# Ma r k Mc Co l l e y 1 2 . 0 0CK# 8 9 0 1 Bo s t o n Av eUr b a n d al e , I A 5 0 3 2 2 4 x $ 3 . 0 0 =

I D# N a n c y Gr e e n 1 4 . 0 0CK# 8 2 3 1 6 t h S tWes t De s Mo i n e s , I A 502 6 5 4 x $ 3 . 5 0 =


7/8

0 1/ 0 8 / 2 00 7 1 3 : 0 3 FAX 5 1 5 2 8 0 2 7 5 4 EMC I NSURANCE EXECUTI VE 2 0 0 9

r


( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be s ame a s o n St a t e me n t o f Or g a n i z a t i o n )Emp l o y e r s Mu t u a l Ca s u a l t y Co . P o l i t i c a l Ac t i o n Comm . f o r Res p o n s i b l e S t a t e Gov l

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE) , L I ST THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD,NOTE : ANY PERSON, OTHER THAN AN I N D I V I D UA L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONS I BI L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD.CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o m m e r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )

$ 9 9 . 1 6$ 8 9 1 . 8 8

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e R e l a t i o n s h i p m u s t b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Page 6 o f 6f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l eA)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-( MMI DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

1 0 / 6 , 1 0 / ( t p , #1 1/ 3 , Mi k e Bo g g s $ 8 . 0 0CK# 5250 C h a p p e l Ct11 / 17 / 06 P l e a s a n t H i l l , I A 5 0 3 2 7 4 x $ 2 . 0 0 =I D#" Ro n Z o s s 1 5 . 0 0CK# 8 0 1 7 Pl u m Dr

a a 50 322 7 5 =I D# Ke n F i t z g e r a l d 5 . 0 0CK# 2 3 0 3 WGi r a r d Av eI n d i a n o l a , I A 5 0 1 2 5 4 x $ 1 . 2 5 =I D#

Nor m An d e r s o n 1 8 . 4 4CK# 8 1 4 E F r a n k l i nI n c i i s i n n I g - ` I A 5 0 1 7 S 4 x S4 6 11D# Ma r k Reese 1 4 . 0 0CK# 4 7 6 5 NW L ov i n g t o n DrDes Mo i n es I A 50 310 4 x $ 3 . 5 0 =

I D# Cu r t Hu s s k e 1 1 . 5 6CK# P . O, Bo x 248Ma x we l l , I A 5 0 1 6 1 4 x $ 2 . 8 9 =1D# S c o t t B u t l e r 1 9 . 1 6CK# 1 0 0 3 0 t h S tDes Mo i n e s I A 5 0 3 1 2 4 x $ 4 . 7 9 =J e a n Bl o o mb u r g 8 . 0 0CK# 4 6 3 8 El m S t r e e tWe s t De s Mo i n e s , I A 502 65 4 x $ 2 . 0 0 =

I D#CK#

CK#


8/8

0 1 / 0 8 / 2 00 7 1 3 : 0 3 FAX 5 1 5 2 8 0 2 7 5 4 EMC I NSURANCE EXECUTI VE Z010

THI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :P u r c h a s e s o f c e r t a i n c a m p a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n S c h e d u l e H. ( R e f e r t o S c h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , m a n a g i n g , o r g a n i z i n g s e r v i c e s m u s t a l s o b e d e t a i l i t e mi z e d o nS c h e d u l e G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o m m i t t e e . ( R e f e r t oS c h e d u l e G i n s t r u c t i o n s a n d I o wa Code 6 8A . 4 0 2 ( 3 ) ( i ) . )

( f o r S c h e d u l e B)

FOR I NSTRUCTI ONS, SEE BACK OF FORM - - SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DEOR L EGI S L AT I VECANDI DATES, L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVA I L ABLE FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t b e s am e a s o n St a t e me n t o f O r g a n i z a t i o n )LEmp l o y e r s Mu t u a l Ca s u a l t y Co . P o l i t i c a l Ac t i o n Comm. f o r Re s po n si b l e S t a t e Go v e r n me n tCANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI D# 9 5 2 L u n d b y f o r I o wa S en a t e Ca n di d a t e Ca mp a i g n C o n t r i b u t i o n

1 1 - 1 3 - 0 6 CK# 1 0 9 6 P 0 . Bo x 6 4 8 $ 1 5 0 . 0 0Ma r i o n , I A 5 2 3 0 2 - 0 6 4 8I D# 1 4 3 9 Wi e c k f o r I o wa Se n a t e Ca n di d a t e Camp a i g n Co n t r i b u t i o n

1 1 - 1 3 - 0 6 CK# 4 3 6 2 Ol d L a ke p o r t Rd 1 0 0 . 0 01 0 9 7 Si o u x C i t y , I A 5 1 1 0 6I D# 1 6 4 5 S u p p o r t e r s o f Ri c k Ol i v e f o r S en a t e Ca n di d a t e Camp a i g n C o n t r i b u t i o n1 1 - 2 7 - 0 6 1 2 6 4 No r t h r i d ge Rd 2 50 . 0 0C1 K# 1 09 8 S t o r y C i t y , I A 5 0 2 48 - 0 2 4 7I D# 6 6 2 Ra n t s f a r S t a t e H o u s e Ca n di d a t e Ca mp a i g n C o n t r i b u t i o n1 1 - 2 7 - 0 6 CK# 2 7 4 0 S Gl a s s S t 2 50 . 0 01100 Si o u x C i t y , I A 51 10 6I D# 1 3 8 5 Mc Ca r t h y f o r S t a t e R e p r e s e n t a t i v e Ca n di d a t e Ca mp a i g n C o n t r i b u t i o n

1 2- 1 4 - 0 6 CK# 5 2 2 0 SE 3 1 s t Ct 10 0 . 0 01 1 0 1 De s Mo i n e s , I A 5 0 3 2 0I D# 9 0 9 8 H o u s e T r u ma n F u n d C o n t r i b u t i o n1 2- 1 4 - 0 6 CK# 1102 5 6 6 1 F l e u r Dr 1 00 . 0 0De s Mo i n e s , I A 5 0 3 2 1I D# 1 6 1 2 C i t i z e n s f o r G r o n s t a l Ca n di d a t e Ca mp a i g n C o n t r i b u t i o n1 2 - 1 4 - 0 6 CK# 2 2 0 B e nn e t t A v e n u e 25 0 . 0 01103 Co u n c i l B l u f f s , I A 51503

I D#CK#

SUB - TOTAL $TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e ) $ 1 , 2 0 0 . 0 0

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