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R C.I
KANSAS GOVERNMENTAL ETHICS COMM~~~Q~ntalEthics Commissio
RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE
January 10,2018
FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
A. Name of Committee: Kansas Physical Therapy Association Political Action Committee
Address: clo Hein Govt. Consulting, LLC., 5845 SW 29th Street
City and Zip Code: Topeka KS 66614-2462
This is a (check one): __ Party Committee .; Political Committee
B. CIH~ck only jf appropriate: Amended Filing __ Tennination Report L
C. Summary (cov~ring the period from January 1,2017 through December 31,2017)
3523.15I. Cash on hand at beginning of period , .
4930.002. Total Conti"ibtltions and Other Receipts (Use Schedl.i1e A) .
8453.153. Cash available this period (Add Lines 1 and 2) d ..
7401.124. Total Expenditures aod Other Disbursements (Use Schedule C) , ..
1052.035. Cash on hand at close ofpetiod (Subtract Line 4 from 3) , .
0.006. In-Kind Contributions (Use Schedule B) .r .......
0.007. Other TransactiOnS (Use Schedule D) ., .
D. "I declare that this report, including any'accompanying schedules and statements, has been examined by me a.od to the best of my knowledge and belief is truc j correct and complete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."
7jJ2//f Date Signature of Treasurer '
GEe Form Rev, 2017
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Physical Therapy Association PAC
(Name of Party Committee or Political Committee)
Date
01/01/17
01/01/17
01/01/17
01/01/17
11/04/17
01/01/17
04/07/17
04/04/17
06/16/17
Occupation of Name and Address Individual Giving More
of Contributor Than $150
Greg Bachman PT P~Pal contribution $50/month 2 12 W. 12th Ave.
'f!. K8 66AOl Sheiii Hill PT PayPal contribution $25/month 5106 S. Mt. Carmel, Wichita 67217
Aimee Bauer Ri.egel PT Paypal contributlon $1 O/month 323 W. 24th, Ha~~76~
Justin Hoover JPT PavPal contrfhutlon $5n/!Y1ontb ~.04 N. Spri.ng Val]~t ~d.!JJJlctiQD....Ci. ty_ KS 0 )J'
Jennifer Westerberg PT 10400 W. 103rd St. #22 Overland Park 66214
'Jackie Dwyer PT PayPal contribution $25/month for
\ m~~ths of l~~ffiear I. KS11 W. 1. th PL. Olath«
, Amanda Britton Carpenter PT 5600 Lamar Avenue ~i.ssi.on KS 66202
Susie Harms PT 3530 Everett Road Manhattan 66503
Jennifer Westerberg PT 10400 W. 103rd St. #22 Overland Park 66214
C..h
Check Appropriate Box.
Ch.ek LODn Eo rlUlds. 0iii0r
V
V
II
V
v'
V
V
V
II
Amount of Cash, Check,
LOlln or Other Receipt
$600.00
$300.00
$120.00
$600.00
$50.00
$225.00
$50.00
$100.00
$150.00
06/16/17
06/16/17
Carolyn Bloom 2011 Hogan Drive lawrence 66047
Cody Barnett 7015 E. Central #3 Wichita KS 67206
PT
PT
V
II
$50.00
$200.00
Subtotal This Pace $2,445.00
pageLOf3
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas Physical Therapy Associalton PAC
(Name of Party Commlllee or political Committee)
Date Name and Address
of Contributor
Occupatfon of Individual Giving More
Than $lS0 Clih
Check Appropriate Box
Chrck LIlia ~ OlhlT
Amount of Cash, Check,
Loan or Other Receipt
12/05/17
Yvonne Colgrove 8785 Oak Country Lane DeSoto 66018
PT
t/ $225.00
12/05/17 Stephen Chandler 909 S. 7th Street Hiawatha 66434
PT
t/ $100.00
12/05/17 Justin Hoover 604 N. Spring Valley Road Junction City KS 66441
PT
V $400.00
12/05/17 Greg Bachman 2812 W. 12th Avenue Emporia, KS 66801
PT
t/ $400.00
12105117 Amy Brldkel 17765 Lookout Manhattan KS
Drive 66502
PT
t/ $60.00
12/05117 Dawn Massey 2707 Crestview Drive Emporia KS 66801
PT
II $70.00
12/05/17 I ~n8tte Honea
502 Sherwood Way Emporia KS 66801
PT
V $60.00
12/05117 Justin Hoover 604 N. Spring Valley Rd Junction Ci.ty KS 66441
PT
t/ $333.00
12/05/17 Gre~ Bachman 28 2 W. 12th Avenue Emporia KS 66801
PT
V $334.00
12/05/17
12105/17
Aaron L1udahl 2231 W. Mai.n phanute KS 66720
Stacey Baker 7315 220th Rd Chanute KS 66720
PT
PT
I
t/
V
$333,00
$50.00
Subtotal Tlifs Paie $2,365.00
page~o~
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Kansas PhysIcal Therapy Association PAC
(Name of Party Commillce or Political Committee)
Date Name and Address
of Co.tributor
Occupation of Individual Giving More
Than $150
Check Appropriate Box
Amount of Cash, Check,
Loan or Other ReceiptCllSh Chock La.n E (anda
Qihej:'"
"
SUbtotAl Thil PlIe , $0.00
Complete if last page of Schedule A
Total Itemized Receipts for Period $4,810.00
Total Unitemized Contributions ($50 or less) $120.00
Sale ofPolitical Materials (Unitemized)
Total Contributions When Contributor Not Known
TOTAL RECEIPTS mtS fElUOD (to line 1 ofSURlm.ry) • $4,930.00
Page 3 or3
SCHEDULED IN-KIND (Non-Monetary) CONTRIBUTIONS
Kansas Physical Therapy Association PAC
(Name of Party Committee or Political Committee)
Date Name and Addre.. of Contributor
Lilt Occupation for ThOle Giving an
In-Kind of More Than SISO
Deacrlptlon of In-Kind Contribution
Value of In-Kind
Contribution
Subtolllli Tbl. PIlGCl $0.00
Complete if last page of Sthedule B
Total itemized (over S100) In-Kind Contributions
Total UnItemized ($ 100 or lell) In-Kind Contributions
'fI'OTAL IN,.K'I~1) OONTRIBUTIONS TillS PERIOD (ro /I111' Ii af S~mlllllr)') $0.00
Page __ of _
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Kansas Physical Therapy Association PAC
(Name of Party Committee or Political Committee)
Date Nanle and Addres.
To Whom Expenditure Is Made Purpose of Expenditure
Amount If Independent or In-kind expenditure in excess of $300 Is
made for II candidate, lilt candidate name & address
See attachment to Schedule C
$7,300.00
I.
Subtotal Thll Plae $7,300.00
Complete jf last page of Schedule C
Totalltcmiud ExpcndituJes This Period $7,300.00
Total Unitemized Expenditures of $50 or less $101.12
TOTAL EXPENDITURES·" OTHER DISBURSEMENTS 11IJS PERIOD (to lIue .. ofSummary)
$7,401.12
Pagc __ of__
2:14 PM KPTA PAC 07/12/18 Check Detail
January through December 2017
Date Name Name Address Paid Amount
0510212017
TOTAL
06/1412017
TOTAL
0611512017
06/14/2017
TOTAL
12/05/2017
12/05/2017
TOTAL
1211312017
12113/2017
TOTAL
1211312017
12/13/2017
TOTAL
12/13/2017
12/1312017
TOTAL
12113/2017
12113/2017
TOTAL
1211312017
12113/2017
TOTAL
12113/2017
1211312017
TOTAL
1211312017
12113/2017
TOTAL
1211312017
1211312017
TOTAL
PayPal
Governmental Ethics Commission
Governmental EthIcs Commission
Governmental Ethics Commission
Baker for State Representatlve
Barker for State Representative
Berger for State Senate
Bollier for State Senate
Bowers for State Senate
Carlin, Sydney for House Committee
Concannon for State Representative
Crum, Steven for State Representatlve
0.00
109 S.Kansas 1st Floor Topeka., KS 66612
0.00
109 S.Kansas 1st Floor Topeka., KS 66612
-50.00
-50.00
109 S.Kans88 1st Floor Topeka., KS 66612
-250.00
-250.00
Rep. Dave Baker 278 Lake Road Council Grove, KS 66846
-200.00
-200.00
Rep. John Barker 103 Wsssinger Avenue Abilene KS 67410
-250.00
-250.00
Sen. Ed Berger 2603 Heather Parkway Suite B Hutchinson KS 67502
-260.00
-250.00
Sen. Barbara Bollier 6910 Overhlll Road MIssion Hills KS 66208
-250.00
-250.00
Sen. Elaine Bowars 1326 N. 150th Road ConcordIa KS 66901
-250.00
-250.00
Rep. Sydney Carlin Box 32 Manhattan, KS 66606
-200.00
-200.00
Rep. Susan Concanon 921 N. Mill Beloit, KS 67420
-250.00
-250.00
Rep. Steven Crum 356 Linden Lane Haysville, KS 67060
-250.00
-260.00
Page 1
2:14PM KPTAPAC 07/12/18 Check Detail
January through December 2017
Date Name Name Address Paid Amount
12113/2017
12/13/2017
TOTAL
Denning for State Senate Sen. JIm Denning 8416 W. 115th Street Overland Park KS 86210
-250.00
-250.00
12/13/2017
1211312017
TOTAL
Estes for State Senate Sen. Maynard "Bud" Estes 1405 Elbow Bend Dodge City, KS 67801
-250.00
-250.00
12/13/2017
1211312017
TOTAL
Hawk for State Senate Sen. Tom Hawk 2600 Woodhaven Court Manhattan KS 68502
-250.00
-250.00
12113/2017
12/1312017
TOTAL
Hawkins for State Representatlve Rep. Dan Hawkins 9406 Harvest lane Wichita KS 87212
-250.00
-260.00
12/13/2017
12/1312017
TOTAL
Hilderbrand for State Senate Sen. Richard Hilderbrand 10337 SE 107th St. Terrace Galena KS 68739
·250.00
-250.00
12/13/2017
1211312017
TOTAL
Hineman for State RepresentatIve Rep. Don Hineman 116 S. Longhorn Road Dighton KS 67839
-250.00
-250.00
12/13/2017
1211312017
TOTAL
Holland for State Senete Sen. Tom Holland Box 185 Baldwin City, KS 66006
-250.00
-250.00
1211312017
12113/2017
TOTAL
HolsCher for State Representative Rep. Cindy Holscher Box 4781 Olathe KS 66063
-200.00
-200.00
12113/2017
12113/2017
TOTAL
Kelly, JIm for State Representatlve Rep. JIm Kelly 309 S. 5tll Independence KS 67301
-250.00
-250.00
12113/2017
12/13/2017
TOTAL
Kelly, Laura for State Senate Sen. Laura Kelly 234 SW Greenwood Ave. Topeka KS 66606-1228
-250.00
-260.00
12/1312017
12113/2017
TOTAL
longblne for Senate Committee Sen. Jeff Longblne Ball 1903 Emporia, KS 66801
-250.00
-250.00
Page 2
2:14 PM
07112118
Date Name
1211312017
1211312017
TOTAL
Masterson for Senate Committee
1211312017
1211312017
TOTAL
McGinn for State Senate
1211312017
1211312017
TOTAL
Murnan for State Representative
1211312017
1211312017
TOTAL
Ousley for State Representative
1211312017
1211312017
TOTAL
Pettey for State Senate
1211312017
1211312017
TOTAL
Phillips for State Representative
1211312017
1211312017
TOTAL
Ratle for State Representative
1211312017
1211312017
TOTAL
Ryckman, Jr. for State Representative
1211312017
12/1312017
TOTAL
Schmidt for State Senate
1211312017
1211312017
TOTAL
Taylor for State Senate
KPTA PAC Check Detail
January through December 2017
Name Address Paid Amount
Sen. Ty Masterson Box 424 Andover KS 67002
-250.00
-250.00
Sen. Carolyn McGinn Box A Sedgwick KS 67135
-250.00
-250.00
Rep. Monica Murnan 1313 Mallory Court Pittsburg, KS 66762
-250.00
-250.00
Rep. Jarrod Ousley 6800 Farley Merriam, KS 66203
-200.00
-200.00
Sen. Pat Pettey 5316 Lakewood Street Kansas City KS 66106
-250.00
-250.00
Rep. Tom Phillips 1530 BarrIngton Drive Manhattan KS 66503
-250.00
-250,00
Rep. Abraham Ratle Box 23796 Overland Park KS 66283
-200.00
-200.00
Rep. Ron Ryckman, Jr. 14234 W. 158th Street Olathe KS 66062
-250.00
-250.00
Sen. Vicki Schmidt 5906 SW 43rd Court Topeka KS 66610·1632
-250.00
-250,00
Sen. Mary Jo Taylor Box 322 Stafford KS 67578
-250.00
·250.00
Page 3
SCHEDULED OTHER TRANSACTIONS
Kan888 Physical Therapy Association PAC ( Name of Parl)' Committee or Political CommUtee)
Date Name a.d Addr... N.tur. of Account or Loan Pay.ble or Lo.. Receivable
Balance at Clo.. of Period
Subln.ll. Tb'- PII.e $0.00
Complete If lalt page of Schedule D
TOT/\L OTHER 'fnA
Plgc__ of__