r-----=:---.ethics.ks.gov/CFAScanned/PACs/2010ElecCycle/201101/PAC115_20… · Greg Biberstein MD...

r-----=:---. KANSAS GOVERNMENTAL ETHICS COMM SSI[ffltED--,

RECEIPTS AND EXPENDITURES REPO T JAN 10 2011 I OF A POLITICAL OR PARTY COMMITT E I

t:CRETARY· iJanuary 10,2011 . OF STATE

FILE WITH SECRETARY· OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Committee: Kansas Medical Society Politicial Action Committee

623 SW 10th Ave. Address: -----'------------------------,-------

City and Zip Code: _T_o_p_e_k_a_,_K:-S_6_6_6_1_2 _

This is a (check one): __ Party Committee .{ Political Committee·

B. Check only if appropriate: __ Amended Filing __Termination Report

C. Summary (covering the period from October 22,2010 through December 31, 2010) """;;'

44,561.401. Cash on hand at beginning of period .

33,345.002. Total Contributions and Other Receipts (Use Schedule A) ~ . I

77,906.403. Cash available this period (Add Lines 1 and 2) .

4,400.004. Total Expenditures and Other Disbursements (Use Schedule C) ..

73,506.405. Cash on hand at close of period (Subtract Line 4 from 3) .

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 failure to file this document or inwtentiOnallY?:::J;.ocu;nent is a class A misdemeanor."

1-7-11 ( . 1~· .,~ . Date Signiture of Treasurer

GEe Form Rev, 2001

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Kansas Medical Society Political Action Committee

Date Name & Address of Contributor

Occupation & Industry of Individual Giving More Than $150

Cash, Check, Loan, Other

Amount of Cash, Check Loan or Other Receipt

12/6/2010 John Adams MD

1133 College Ave Ste E230 Manhattan, KS 66502-2779

Physician

. Healthcare Industry

Check ($150.00)

12/29/2010 Rebecca Allard MD

221 WIst St Saint Francis, KS 67756-9999

Physician

Healthcare Industry

Check ($150.00)

11/17/2010 Melinda Allen-Cullins MD

2810 County Rd 4350 Coffeyville, KS67337-7900

Physician

Healthcare Industry

Check ($150.00)

12/16/2010· Craig Anderson MD

20375 W 15151 St Ste463 Olathe, KS 66061-7207

Physician

Healthcare Industry

Check ($150.00)

12/16/2010 Wayne Anliker MD

1301 W 12th Ave Ste 106 . Emporia, KS 66801-2588

Physician

Healthcare Industry

Check ($150.00)

12/17/2010 James Appelbaum MD

8919 Parallel Pkwy Ste 555 Kansas City, KS 66112-3628

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Paul Arnold MD

5045 Sudler Hall Kansas City, KS 66160-0003

Physician

Healthcare Industry

Check ($150.00)

12/22/2010 Errick Arroyo MD

10600 Quivira Rd Ste 320 Shawnee Mission, KS 66215-2311

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Zeferino Arroyo MD

311 E Spruce St Garden City, KS 67846-5614

Physician Healthcare Industry

Check ($150.00)

12/2/2010 Dennis Artzer MD

920 SW Washburn Ave Topeka, KS 66606-1527

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Monica Bachamp DO

1831 E Iron Ave Salina, KS 67401-3418

Physician

Healthcare Industry

Check . ($150.00)

11/22/2010 Louis Badeen MD

10600 Quivira Rd Ste 460

Shawnee Mission, KS 66215-2312

Physician

. Healthcare Industry

Check ($150.00)

Subtotal This Page ($1,800.00)

Page 1 of 20




Occupation' & Industry of Individual Giving More Than $150



11/22/2010 Gary Baker MD

8787 Ballentine St Ste 2800 Shawnee Mission, KS 66214-1987

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Jeremy Baptist MD

6806 W 83rd St Shawnee Mission, KS 66204-3956

Physician .

Healthcare Industry

Check ($150.00)

1211/2010 Marc Baraban MD

823 SW Mulvane St Ste 200 Topeka, KS 66606-1679

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 James Barnett MD

901 SW Garfield Ave Topeka, KS 66606-0907

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Tammy Battaglia MD

1 Mt Carmel Way Pittsburg, KS 66762-7587

Physician

Healthcare Industry

Check ($150.00)

12/6/2010 Saroj Bavishi MD

20375 W 151st St Ste407 Olathe, KS 66061-7209

Physician

Healthcare Industry

Check ($150.00)

11/22/2010 Donald Beahm MD

PO Box 9 Great Bend, KS 67530-0009

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Greg Biberstein MD

1133 College Ave Bldg E Manhattan,KS 66502-2700

Physician

Healthcare Industry

Check ($150.00)

12113/2010 Patrick Blatchford MD

216 Birch Ave Arkansas City, KS 67005-9856

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Fred Bodker MD

7504 Antioch Rd Shawnee Mission, KS 66204-2622

Physician

Healthcare Industry

Check ($75.00)

12/13/2010 Brandi Boller DO

1411 W 15th St Liberal, KS 67901-2549

.Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Celeste Brabec MD

12200 W 106th St Ste120


Physician

Healthcare Industry

Check ($150.00)


Page 2 of20







12117/2010 Jake Breeding MD

501 S Sante Fe Ave Ste 200 Salina, KS 67401-4189

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 William Brooks MD

5800 Foxridge Dr Ste 240 Shawnee Mission, KS 66202-2490

Physician

Healthcare Industry

Check ($150.00)

1111112010 R. Kevin Bryant MD

6130 E Central Ave Ste 117 Wichita, KS 67208-4238

Physician

Healthcare Industry

Check $300.00

12/29/2010 Martin Buckman MD


Physician

Healthcare Industry

Check ($150.00)

11/22/2010 Charles Butrick MD

12200 W 106th St Ste 130 Shawnee Mission, KS 66215-2305

Physician

Healthcare Industry

Check ($150.00)

11/23/2010 Harley Calvin DO

316 E Custer St Ness City, KS 67560-1654

Physician

Healthcare Industry

Check ($150.00)

11123/2010 Anthony Canfield MD

1411 W 15th St Ste 302 Liberal, KS 67901-2285

Physician

Healthcare Industry

Check ($150.00)

12/22/2010 William Chase MD


Physician

Healthcare Industry

Check ($150.00)

12113/2010 Jason Cheney MD

500 Country Club Dr Beloit, KS 67420~2603

Physician

Healthcare Industry

Check ($150.00)

12110/2010 Mary ChemoffMD

8929 Parallel Pkwy Kansas City, KS 66112-1636

Physician

Healthcare Industry

Check ($150.00)

11111/2010 Jerry Cohlmia MD

818 N Emporia St Ste 310

Wichita, KS 67214-3727

Physician

Healthcare Industry

Check $300.00.

12113/2010 Craig Concannon MD

PO Box 587 Beloit, KS 67420-0587

Physician

Healthcare -Industry

Check ($150.00)


Page 3 of20







12/16/2010 Kye Evans DO

5903 Longleaf Cir LaWrence, KS 66049-5807

Physician

Healthcare Industry

Check ($100.00)

11/23/2010 Douglas Fain MD

3700 W 83rd St Ste 203 Shawnee Mission, KS 66208-5120

Physician

Healthcare Industry

Check ($150.00)

11/1112010 Elaine Ferguson DO

617 E Elm St Salina, KS 67401-8534

Physician

Healthcare Industry

" Check ($100.00)

12/2/2010 Lynn Fisher MD

1210 N Washington St Plainville, KS 67663-2505

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Leonard Fleske MD

1514 NW K 96 Hwy Great Bend, KS 67530-3012

Physician

Healthcare Industry

Check ($150.00) .

12/2212010 Matthew Floersch MD

1133 College Ave Bldg C Ste 143 Manhattan, KS 66503-2770

Physician

Healthcare Industry

Check ($150.00)

11/17/2010 Dale Friesen MD

330 Arkansas St Ste 210 Lawrence, KS 66044

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Eric Fry MD

310 E Walnut St Ste 101 Garden City, KS 67846-2284

Physician

Healthcare Industry

Check ($150.00)

12/22/2010 Daniel Frye MD

9501 State Ave Ste 3 Kansas City, KS 66111-1871

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Carl Fugate MD


Physician

Healthcare Industry

Check ($150.00)

"12/29/2010 Magno Gabales MD

8801 Eby St Shawnee Mission, KS 66212-3638

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Jason Gallagher MD

1133 College Ave Bldg E Manhattan, KS 66502-2700

Physician

Healthcare Industry

Check ($150.00)


Page 5 of 20



Date Name & Address of Contribu tor




1112212010 Mindi Garner DO

127 W 5th St Pittsburg, KS 66762-6600

Physician

Healthcare Industry

Check ($150.00)

11/23/2010 Crosby Gemon MD

300 Utah St Hiawatha, KS 66434-2314

Physician

Healthcare Industry

Check ($150.00)

12/16/2010 Kevin Giblin MD

325 Maine St Lawrence,KS 66044-1393

Physician

Healthcare Industry

Check ($100.00)

12/1/2010 Douglas Girod MD

3901 Rainbow Blvd

Kansas City, KS 66160-7380

Physician

Healthcare Industry

Check ($150.00)

12/17/2010 Richard Glover MD

1715 Medical Pkwy Newton, KS 67114-4446

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 David Goering MD


Physician .

Healthcare Industry

Check ($100.00)

12/16/2010 Anthony Goetting DO


Physician

Healthcare Industry

Check ($100.00)

12129/2010 Douglas Goracke MD

1301 N 2nd St Atchison, KS 66002-1297

Physician

Healthcare Industry

Check ($100.00)

12/2212010 Michel Gratia MD

3100 Cannery Row Apt B Dodge City, KS 67801-8921

Physician

Healthcare Industry

Check ($75.00)

12/29/2010 Karen Graves DO

2900 Amherst Ave Manhattan, KS 66503-3093

Physician

Healthcare Industry

Check ($140.00)

12/13/2010 Gary Grimaldi MD

2711 S Rouse St Ste B Pittsburg, KS 66762-6621

Physician

Healthcare Industry

Check ($150.00)

12/17/2010 Mark Gros MD

1620 Charles PI Manhattan, KS 66502-2750

Physician

Healthcare Industry

Check ($150.00)


Page 6 of20



12/29/2010

12/29/2010

12116/2010

1211/2010

12113/2010

12/22/2010

12/29/2010

12/2/2010

12/22/2010

12/2/2010

12/2/2010

12/16/2010

Occupation & Industry of Name & Address

Individual Giving More of Contributor

Than $150

Douglas Gruenbacher MD Physician

PO Box 510 Healthcare Industry Quinter, KS 67752-0510

Shelly Gruenbacher MD Physician

501 Garfield St Healthcare Industry Quinter, KS 67752-9795

Chad Gustin MD Physician

325 Maine St Healthcare Industry Lawrence, KS 66044-1393

David Harden MD Physician

. 1640 Charles PI Ste 103 Healthcare Industry Manhattan, KS 66502-2868

Matthew Harms MD Physician


Terry Harter MD Physician

11400 158th Rd Box 249 Healthcare Illdustry Mayetta, KS 66509-0249

Robyn Hartvickson MD Physician

1715 Medical Pkwy Healthcare Industry Newton, KS 67114-4446

Steve Haug MD Physician

1133 College Ave Bldg E Healthcare Industry Manhattan, KS 66502-2700

J. Anthony Heit MD Physician

10600 Quivira Rd Ste 320 Healthcare Industry Shawnee Mission, KS 66215-2311

David Hellman MD Physician 1104 Pearce St Healthcare Industry Wichita, KS 67203-3545

David Hendrick MD Physician

300 WPark Ln Healthcare Industry Salina, KS 67401-3553

James Herrin MD Physician


Subtotal This Page


Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check


($150.00)

($150.00)

($100.00)

($150.00)

($100.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($100.00) .

($1,650.00)

Page 7 of20




Occupation & Industry of Individual Giving More Tban $150

11/22/2010 Steven Hess MD

20375 W 151st St Ste 205 Olathe, KS 66061-5360

Physician

Healthcare Industry

12/2/2010 Michael Hettinger MD

7504 Antioch Rd Shawnee Mission, KS 66204-2622

Physician

Healthcare Industry

12/29/2010 James Hignight MD

218 W 4th Ave Caney, KS 67333-1462

Physician

Healthcare Industry

12/13/2010 Randall Hildebrand MD

1514 K 96 Hwy Great Bend, KS 67530-3012

Physician

Healthcare Industry

12/29/2010 Douglas Hinkin MD

4101 Anderson Ave Manhattan, KS 66503-4512

Physician

Healthcare Industry

12/13/2010 Dai Trang Ho MD

325 Maine St Lawrence, KS 66044-1393

Physician

Healthcare Industry

12/29/2010 Troy Holdeman MD

1715 Medical Pkwy Newton, KS 67114-4446

Physician

Healthcare Industry

11/11/2010 Kevin Hoppock MD

9211E21stStN Wichita, KS 67206-2925

Physician

Healthcare IndustrY

12/13/2010 Stanley Hornbaker MD

1988 Pecan Valley Ct Lawrence, KS 66047-1882

Physician

Healthcare Industry

12/29/2010 Greg Horton MD

5002 Eaton Hall Kansas City, KS 66160-7415

Physician

Healthcare Industry

11/11/2010 Martha Housholder MD

835 N Hillside St Wichita, KS 67214-4913

Physician

Healthcare Industry

12/29/2010 Robert Huebner MD

1243 S 100th St McCune, KS 66753-9802

Physician

Healthcare Industry

Subtotal This Page

Casb, Cbeck, Loan, Otber

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Amount ofCasb, Cbeck Loan or Otber Receipt

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($100.00)

($85.00)

($300.00)

($100.00)

($150.00)

($300.00)

($150.00)

($1,935.00)

Page 8 of20




Occupation & Industry of Individual Giving More . Than $150



1211/2010 Kevin Hughes DO


Physician

Healthcare Industry

Check ($150.00)

11117/2010 Steven Hull MD

10590 Barkley St Shawnee Mission, KS 66212-1811

Physician

HeaIthcare Industry

Check ($150.00)

12113/2010 Brian Hunt MD


Physician He'althcare Industry

Check ($100.00)

11123/2010 Mikhail Imseis MD

722 E Locust St Ness City, KS 67560-1726

Physician

Healthcare Industry

Check ($150.00)

12/22/2010 . Kelly Ivester MD

1133 College Ave Bldg E120 Manhattan, KS 66502-2700

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Devendra Jain MD

PO Box 236 Parsons, KS 67357-0236

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Jonathan Jantz MD

700 Medical Ctr Dr Ste 150 Newton, KS 67114-9015

Physician

HeaIthcare Industry

Check ($150.00)

12/30/2010 Betsy Johns MD

601 SW Corporate View Rd Ste 200 Topeka,KS 66615-1004

Physician

Healthcare Industry

Check ($150.00)

11/23/2010 Carlo Jurani MD


Physician

Healthcare Industry

Check ($150.00)

12/13/2010 John Keller MD

1112 W 6th St Ste 210 Lawrence, KS 66044-2249


Check ($150.00)

12/13/2010 Brewster Kellogg DO

.310 E College Dr Colby, KS 67701-3716

Physician

HeaIthcare Industry

Check ($150.00)

12/29/2010 . Spencer Kerley MD

7800 W 110th St Shawnee Mission, KS 66210-2304

Physician

Healthcare Industry

Check ($150.00)


Page 9 of20



12/13/2010

12/13/2010

12/1/2010

12/22/2010

12/2/2010

12/13/2010

11/22/2010

12/13/2010

12/16/2010

12/29/2010

12/2/2010

12/2/2010

Name & Address of Contributor


Jason Kimball MD Physician

325 Maine St Healthcare Industry

La~ence,}CS 66044-1393

Kris Kimple MD Physician

PO Box 587 Healthcare Industry Beloit,}CS 67420-0587

Kent Kiracofe MD Physician

4101 Anderson Ave Healthcare Industry Manhattan, KS 66503-4512

Martin Klenda MD Physician

PO Box 587 Healthcare Industry Beloit,}CS 67420-0587

Rebecca Klingler MD Physician

1133 College Ave Bldg E Healthcare Industry Manhattan, KS 66502-2700

Nathaniel Knackstedt DO Physician

252 W 9th St Healthcare Industry Hoisington, KS 67544-1725

Ryan Knopp MD Physician

4101 Anderson Ave Healthcare Industry Manhattan, KS 66503-4512

Natalie Koederitz MD Physician

1112 W 6th St Ste 214 Healthcare Industry La~ence, KS 66044-2249

Christopher Koenig MD Physician

12330 Metcalf Ave Ste 570 Healthcare Industry Shawnee Mission,}CS 66213-1324

Elizabeth Koerner MD Physician

609 Liberty St Healthcare Industry "Clay Center,}CS 67432-1564

Jennifer Koontz MD Physician

800 Medical Center Dr Ste 240 Healthcare Industry

Newton, KS 67114-2259

Preston Koprivica MD Physician

10127 Leavenworth Rd Healthcare Industry

Kansas City, KS 66109-3050

Subtotal This Page


Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check


($100.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($140.00)

($150.00)

($150.00)

($150.00)

($1,740.00)

Page 10 of20




Occupation & Industry of Individual Giving More Than $150 .

12/29/2010 Frank Koranda MD

8800 W 75th St Ste 140


Physician

Healthcare Industry

12/13/2010 Ernest Kovarik MD

6001 SW 6th Ave 3rd Floor Topeka, KS 66615-1004

Physician

Healthcare Industry

12/1/2010 Randall Kresie MD

6001 SW 6th Ave Ste 210

Topeka, KS 66615-1006

Physician

Healthcare Industry

12/16/2010 Michael Kucenic MD

2200 SW 6th Ave Topeka, KS 66606-1707

Physician

Healthcare Industry

11/17/2010 Sarah Landers MD

330 Arkansas St Ste 210 La~ence, KS 66044

Physician

Healthcare Industry

11/17/2010 Michael Lange MD .

330 Arkansas St Ste 210 La~ence,KS 66044

Physician

Healthcare Industry

12/29/2010 Jeff Lawhead MD

7121stTer Lansing, KS 66043-1704

Physician

Healthcare Industry

11/23/2010 David LeeMD


Physician

Healthcare Industry

12/29/2010 James Lehman MD

1108 Morgan Ln Manhattan,KS 66503-7574

Healthcare Industry

12/29/2010 Kenneth Lindsey MD

2220 Canterbury Dr Hays, KS 67601-2370

Physician

Healthcare Industry

11/11/2010 John Lohnes MD

551 N Hillside St Ste 320 Wichita, KS 67214-4926

Physician

Healthcare Industry

12/16/2010 Paul Loney MD

325 Maine St

La~ence, KS 66044-1393

Physician

Healthcare Industry

Subtotal This Page


Check


($140.00)

Check ($150.00)

Check ($150.00)

Check ($50.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($300.00)

Check ($100.00)

($1,790.00)

Page 11 of20







.J

12/17/2010 Frank Lyons MD

1133 College Ave Bldg E120 Manhattan, KS 66502-2700

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Michael Machen MD

PO Box 510 Quinter, KS 67752-0510

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Amy Madril MD

505 S Plummer Ave Chanute, KS 66720-0946

Physician

Healthcare Industry

Check ($150.00)

12/1/2010 Joshua Mammen MD

3901 Rainbow Blvd MS 2005 Kansas City, KS 66103-2937

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Christine Marozas DO


Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Darren Matchell DO

310 E College Dr Colby, KS 67701-3716

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Mark McCune MD


Physician

Healthcare Industry

Check ($150.00)

12/1/2010 Paul McKesey MD

700 W Central Ste 406 El Dorado, KS 67042-2116

Physician

Healthcare Industry

Check ($150.00)

11/11/2010 Jeffery McKinley DO

PO Box 250 Norton, KS 67654-0250'


Check ($1'50.00)

11/11/2010 Joseph Meek MD

8825 Shadowridge St WiChita, KS 67226-2115

Ph~sician

Healthcare Industry

Check ($300.00)

12/16/2010 Brad Meister MD

PO Box 678 Parsons,KS 67357-0678

Physician

Healthcare Industry

Check ($150.00)

11/22/2010 Bruce Melin MD

410 E Walnut St Garden City, KS 67846-5672

Physician

Healthcare Industry

Check ($150.00)


Page 12 of 20




Occupation & Industry of Individual Giving More

. Than $150



12/2912010 Roy Menninger MD

2955 SW Wanamaker Dr Topeka, KS 66614-5318

Physician

Healthcare Industry

Check ($150.00)

12/2212010 Brian Metz MD


Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Mary Miller MD

221 WIst St Saint Francis, KS 67756-9999

Physician

Healthcare Industry

Check ($150.00)

12/6/2010 Stephen Miller DO

POBox 489 Coffeyville, KS 67337-0498

Physician

Healthcare Industry

Check ($150.00)

11/22/2010 Vernon Mills MD

3550 S 4th St Ste 120 Leavenworth, KS 66048-5061

Physician

Healthcare Industry

Check ($150.00)

12/29/2010 Sharon Mitchell MD

13 Village Plaza Liberal, KS 67901

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Kimberly Moore MD

304 Settlers Dr Lawrence, KS 66049-2030

Physician

Healthcare Industry

Check ($100.00)

11/17/2010 Robert Moser MD

PO Box 640 Tribune, KS 67879-0640

Physician

Healthcare Industry

Check ($150.00)

12/16/2010 Kevin Mosier MD

POBox 678 Parsons, KS 67357-0678

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Stephen Munns MD


Physician

Healthcare Industry

Check ($150.00)

12/16/2010 John Murphy MD

3550 S 4th St Leavenworth, KS 66048-5061

Physician

Healthcare Industry

Check (~150.00)

12/29/2010 Victor Nemechek MD

PO Box 510 Quinter, KS 67752-0510

Physician

Healthcare Industry

Check ($150.00)


Page 13 of20





12/16/2010 Joseph Petelin MD

9119 W 74th St Shawnee Mission, KS 66204-2202

Physician

Healthcare Industry

12/13/2010 Edwin Petrik MD

1414 SW 8th Ave Topeka,KS 66606-1535

Physician

Healthcare Industry

11/22/2010 Pamela Pierce MD

1701 E 23rd Ave Hutchinson, KS 67502-1191

Physician

Healthcare Industry

12/2/2010 Roman Pohorecki MD

2140 Nevada Dr Liberal, KS 67901-5403

Physician

Healthcare Industry

12/29/2010 James Prescott MD

823 N Main St McPherson, KS 67460-2839

Physician

Healthcare Industry

12/16/2010 Sabrina Prewett DO


Physician

Healthcare Industry

12/10/2010 Eric Purdom MD

4201 Anderson Ave Bldg C Manhattan, KS 66503-7603

Physician

Healthcare Industry

12/16/2010 Stella Quiason MD


Physician

Healthcare Industry

12/2/2010 Gregory Quinlan DO

916 Highway 69 Fort Scott, KS 66701-8750

Physician

Healthcare Industry

12/16/2010 Pamela Ramsey MD

11730 S Hagan St Olathe, KS 66062-1121

Physician

Healthcare Industry

12/16/2010 Gurpreet Randhawa MD

1411 W 15th StSte 202 Liberal, KS 67901-2285

Physician

Healthcare Industry

12/22/2010 Bell Razafindrabe MD

3515 Broadway Ave Great Bend, KS 67530-3633

Physician

Healthcare Industry

Subtotal This Page


Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check

Check


. ($150.00)

($50.00)

($150.00)

($150.00)

($150.00)

($100.00)

($150.00)

($150.00)

($150.00)

($100.00)

($150.00)

($150.00)

($1,600.00)

Page 15 of20


.Kansas Medical Society Political Action Committee



Cash, Check,'Loan, Other


12/2/2010 Stephen Resnick DO

1224 N Bracken St Wichita, KS 67206-4125

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Esther Rettig MD

901 N Main St McPherson, KS 67460-2841

Physician

Healthcare Industry

Check ($150.00)

12/16/2010 Michael Reynolds MD

1301 W 12th Ave Ste 106 Emporia, KS 66801-2572

Physician

Healthcare Industry

Check ($150.00)

12/1612010 Scott Robinson MD


Physician

Healthcare Industry

Check ($100.00)

12/2/2010 Graham Rose MD

1133 College Ave Bldg E Manhattan, KS 66502-2700

Physician

Healthcare Industry

Check ($150.00)

12/2912010 Terry Rothstein MD

POBox B Parsons, KS 67357-2226

Physician

Healthcare Industry

Check ($150.00)

12/17/2010 Christopher Rupe MD

135 Overhill Rd Salina, KS 67401-3580

Physician

Healthcare Industry

Check ($150.00) .

12/29/2010 Lance Saville MD

1133 College Ave Bldg A Ste 213 Manhattan, KS 66502-2212

Physician

Healthcare Industry

Check ($150.00)

12/13/2010 Marc Scarbrough MD 325 Maine St Lawrence,KS 66044-1393


Check ($100.00)

12/2/2010 . Joseph Schlageck MD .

2103 Meadowlark Rd Manhattan, KS 66502-3381

Physician

Healthcare Industry

Check ($150.00)

11/17/2010 Stephanie Schmidt MD

330 Arkansas St Ste 210 Lawrence,KS 66044

Physician

Healthcare Industry

Check ($150.00)

12/2/2010 Earl Schulte MD

PO Box 100. Hutchinson, KS 67504-0100

Physician

Healthcare Industry

Check ($150.00)


Page 16 of20





12/2/2010 James Sebghati MD

20805 W 151 st St Ste 224 Olathe, KS 66061-5628

Physician

Healthcare Industry

12/1312010 Matthew Shaffer MD

501 S Santa Fe Ave Ste 210 Salina, KS 67401-4189


12129/2010 Bal Sharma MD

POBox 3892 Topeka, KS 66604-3892

Physician

Healthcare Industry

12/2/2010 Virender Singhal MD

2401 Gilham Rd KansasCity,MO 64108-4619

Physician

Healthcare Industry

11/2312010 Susan Speaks MD

3905 Snowy Reach Manhattan, KS 66503-7559

Physician

Healthcare Industry

12/1/2010 Donald Stallard MD


Physician

Healthcare Industry

12/29/2010 Shawn Stanley MD

2100 Baptiste Dr Paola, KS 66071-0891

Healthcare Industry

12/22/2010 Stephen Stevenson MD

11400 158th Rd Box 249 Mayetta,KS 66509-0249

Physician

Healthcare Industry

12/2/2010 Daniel Stewart MD


Physician

Healthcare Industry

12/30/2010 Jill Stewart MD

1345 County Road 82 Quinter, KS 67752-6038

Physician

Healthcare Industry

. 11/23/2010 Charles Striebinger MD


Physici~n

Healthcare Industry

11/23/2010 Daniel Suiter MD

420 Country Club Rd Ste 100 Pratt, KS 67124-3125

Physician

Healthcare Industry

Subtotal This Page

Cash, Check, Loan, Amount of Cash, Check Other·· Loan or Other Receipt

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

Check ($150.00)

($1,800.00)

Page 17 of20


Kansas Medkal Society Political Action Committee



12/29/2010 Lara Sullivan MD

8308 High Dr Shawnee Mission, KS 66206-1524

Physician

Healthcare Industry

12/13/2010 Rick Tague MD

1501 SW Auburn Rd Topeka, KS 66615-1503

Physician

Healthcare Industry

12/13/2010 Ann Taylor DO

252 W 9th St Hoisington, KS 67544-4565

Physician

Healthcare Industry

12/13/2010 E. Bruce Toby MD


Physician

Healthcare Industry

12/29/2010 Wade Turner MD

1230 E 6th Ave Ste 18 Winfield, KS 67156-2407

Physician

Healthcare Industry

11/22/2010 Eva Vachal MD

1610 E Johnson St Garden City, KS 67846-4746

Physician

Healthcare Industry

12/29/2010 Kipp Van CampDO

1230 SW Harvey St Ste B Topeka, KS 66604-7832

Physician

Healthcare Industry

12/22/2010 Hannah Vargas MD


Physician

Healthcare Industry

12/10/2010 Surendra Verma MD

108 Suffolk Ct Garden City, KS 67846-8464

Physician

Healthcare Industry

11/23/2010 Roderick Warren MD

300 UtahSt Hiawatha, KS 66434-2314

Physician

Healthcare Industry

12/16/2010 Larry Watts MD

3550 S 4th St

Leavenworth, KS 66048-5085

Physician

Healthcare Industry

11/22/2010 Chance Williams MD

1554 18th Rd

Clay Center, KS 67432-2021

Physician

Healthcare Industry

Subtotal This Page


Check

Check

Check

. Check

Check

Check

Check

Check

Check

Check

Check

Check


($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($150.00)

($1,800.00)

Page 18 of20



12/13/2010

11/23/2010

12/13/2010

12/29/2010

11/23/2010

Name & Address of Contributor

Jorge Wong MD

730 Medical Ctr Dr Newton, KS 67114-8778

Kendall Wright MD

1301 W 12th Ave Ste 301 Emporia, KS 66801-2590

Charles Yockey MD

325 Maine St La~ence,KS 66044-1393

Charles ZeIT MD

707 Grant St Atwood, KS 67730-1220

Bruce Zimmerman MD


Subtotal This Page

Occupation & Industry of IndiVidual Giving More Than $150

Physician

Healthcare Industry.

Physician

Healthcare Industry

Physician

Healthcare Industry

Physician

Healthcare Industry .

Physician

Healthcare Industry


Check

Check

Check

Check

Check


($150.00)

($150.00)

($100.00)

($150.00)

($150.00)

($700.00)

Page 19 of20



(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 Check LoaD Othn

Other Receipt

Credit ck #2323 - Lanze Kinzer Representative 12/8/10 12549 S. Brougham Dr. ,f $500.00

Olathe, KS 66062

Credit ck #2311- Sean Gatewood Representative 12/30/10 1628 NW 33rd PI. $250.00

Olathe, KS 66618

$750.00

Complete if last page of Schedule A

Total Itemized Receipts for Period $33,345.00

Total Unitemized Contributions ($50 or less)

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known

$33,345.00

Page~of~

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Medical Society Political Action Committee Purpose of Expenditure

Date Name and Address List candidate name & address if independent or in-kind expenditure in excess of $300

Amount $

10/27/10 Jim Denning 11184 Antioch Ste 290 Overland Park KS 66210

Campaign Contribution . 500.00

11/11110 SedgPAC 1102 S Hillside Wichita KS 67211

Transfer membership 900.00

11115110 Senate Republican Leadership PO Box 1772 Topeka KS 66601

Campaign Contribution 500.00

12/28/10 Les Osterman 1401 W Dallas Wichita KS 67217


12/28/10 Sean Gatewood 1628 NW 33'd 1'1 Topeka KS 66618


12/28110 Brian Weber PO Box 804 Dodge City KS 67801


12/2811 0 Kyle Hoffmap. PO Box 621 Bucklin KS 67834


12/28110 Amanda Grosserode 12601 West 99th St Lenexa KS 66215


Subtotal This Page $4,400.00

Page _1 of-1.

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

. Kansas Medical Society Political Action Committee

(Name of Party Committee or Political Committee)

AmountPurpose of ExpenditureName and Address To Whom Expenditure is Made

Date

$0.00

Complete if last page of Schedule C

Total Itemized Expenditures This Period $4,400.00

Total Unitemized Expenditures of $50 or less

$4,400.00

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