of a/political or party committee...

------------------------------

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__


KANACRNA PAC


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


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__


KANA CRNA PAC



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__


KANA CRNA PAC

(Name of Party Committee or Political Committee) ,


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__


KANA CRNA PAC


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


$1,400.00

Page _5_ of__


KANA CRNA PAC


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__·_


KANA CRNA PAC


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


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


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


KANA CRNA PAC



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


12109/09 Phil Hermanson 5338 S Mosley Wichita,KS 67216


12109/09 Geraldine Flaharty 1816 E Femwood Wichita,KS 67216


12109/09 Aaron Jack 1330 N Robin Ct Andover,KS 67002


12109/09 Michael R O'Neal 8 Windemere Ct Hutchinson.KS 67502


12109/09 Clay Aurand 213630 Rd Courtland,KS 66939 0


12109/09 Bob Bethell 104 E 3rd Box 186 Alden,KS 67512


12109/09 Melvin Neufeld 740515 Rd Ingalls,KS 67853


12109/09 Pat George 3007 Westview Dodge City.KS 67801


12109/09 James Morrison #3 Cottonwood Dr Box366 Colby,KS 67701


$2,250.00

Page _._2_ of_·_


KANA CRNA PAC


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


KANA CRNA PAC



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


12109/09 Mike Kiegerl 2350 Golf Course Rd Olathe,KS 66061


12109/09 Barbara Ballard 1532 A1vamar Lawrence,KS 66047


12109/09 Scott Schwab 14953 W 140th Ter Olathe,KS 66061


12109/09 Lana Gordon 5820 SW 27th St Topeka,KS 66614


12109/09 Annie Tietz 329 SW Yorkshire Rd Topeka,KS 66606


12109/09 Don Hill 1720 Luther Emporia,KS 66801


12109/09 Gerald T Henry 3515 Neosho Rd Cummings,KS 66016


12/09/09 Tom Hawk 3115 Harahey Ridge Manhattan,KS 66502


$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


.. 12109/09 -Clark- Shultz 707 Washington Cir _Lindsborg,KS 67456

·-Campaign Conttibution $200,Ocr ..

-12109/09 Don Schroeder 13114th Ave Inman,KS67546


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


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


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__

of a/political or party committee...

Documents