------

-- -

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,,-C .VED)

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01/05/2012. 15:17 Physicians Development Group, (FAX)316 265 4379 P.002/01S, _

RECEIVED . . . KANSAS GOVERNMENTAL ETHICS COMMISSION

MAY 27 2014 RECEIPTS 00 ExPENDITURES REPORT ·OFJA CANDIDATE FOR STATE OFFICE

KS Governmental Ethics CommIssion ·January 10,2012

FILE WITH SECRETARY OF STATE SEE REVERSE 'SIDE FOR INSTRUCTIONS

.~

.A. Name of Candidate: _P_h_i_1_H_er_rn_a_"_s_o_n_·-------~~l_+_v.,t_t==-,

Address: 5338 S.Mosley

City. ~d Zip Code: Wichita, KS 67216

OfficeSought: State Representative

County: Sedgwick.

District: 96

x . B. Check only if appropriate: __Amended Filing _.'_._. Termination Report

D. "1 declare that this report, including any accompanying schedules and 5tat~ents, has been exarillned by me and to the best ofmy knowledge and belief is true, correct and mplete. I understand that the intentional failure to file this document or intentionally filing a false do .- . ent is a class A misdemeanor."

C. S~ary (covering the period. from January 1,2011 through December 31,2011)

1. Cash on hand at beginning ~fperi~d ;.: ; , ; , .

2. Total Contributions and Other R~ceipts (Use Schedule A) .

3. Cash availilblethis.period (Add Lines I.and 2) : ..

4.. Total ExpenditiJres and Other Disbursements (Use Schedul~·q , : ~: :

5. Cash on hand at close of period (Subtract Line 4 from 3) : ~ ; ..

6. In TT' 'd'C' ."'b' (U S h dul B)'-~'-lll ontn utlODS se c e e ::. . 39300..

'7. Other J::ransactions (Use Schedule D) ..

6'fJ·/tt \0-537 ./1'17-).35. ).1

LI q t:f !.J.Oj."11 A4J. ).6'

GECForm Rev, 2001

(FAX)316 265 4379 P.003/016'01/05/2012 15:17 Physicians Development Group

SCBEDULEA CONTRmUTIONS AND OTHERRECEIPTS . .

Phil Hermanson

(Name of Candidau:)

Name lind Address DaCe ofConCributor

PlI.ge J__ of

Farmers Alliance Mutuannsurance Insurance Company 07/21/111122NMain .

McPherson, KS.67460

Kansas Bankers Asoocialion PAC PAC '07/05/11 P a Box 4407

Topeka. KS. 66604-0407

. Kansas bplometric PAC PAC 07/05/11. 1266 S W Topeka Blvd.

topeka, KS. 66612

Kansas Comm. for Rural Electric 07105/11 POBox 790

Meade. K8. 67864-0790

Occupation & InduStry of Individual GivinI;: More

Than S150

Committee for Electric Power in Rural areas

. ' Polsjnelll Shughart Law Firm 07122111 700 W .41st St Ste. 1000

':,;;:-.'. .~ansa~ City, MO. 64112

Kansas Contractors Assoc. PAC PAC 07122111 316 W 33rd St.;P 0 80x 5061

Topeka,KS.6660S .

Lobbyist Firm 08/04/11 900 S. Kansas Ave.

Topeka, KS 66612

Hickam Public Affairs Inc.

PAC 08/04111 623 SW10th Ave .

Topeka, KS 66612

Kansas Medical Society PAC

ATT Phone-Media Company 08/04/11 154 N. Broadway

Wichita

,Kansas Hospital Ass.oc. PAC PAC 06/30/11 215 S E 8th Ave.

Topeka, KS 66603

Check Amount of 4Ppropriate Box Cl15b, Check,

I--"';":"":-"':""'--...--.....j LoRn or Otber C..h Chttk Loin F'oi:.:~· Receipt

.,

'" $250.00

I $250.00

$500.00.f

. $250.00 ~.f

$250.00

'" ,f $100.00

.f $100.00

\I $500.00

$500.00.f'

,f $250.00

$300.00

$3,250.00

__'

(FA)()316 265 4379 P.004/01S01/05/2012 15:18 Ph~'sicrans Development Group

. SCHEDULE A ·CONTRIBUTlONS AND OTHER RECEIPTS

Phil Hermans.on

(Name of CLUldidale)

Datc N:lme and A·ddress

of Contributor

Occupation & Industry of Individual Giving More

Thlln $150 .

10/05/11 Sara Meng 2250 Leo St. Goddard, KS67052

Dentist·

10/05/11 Matthew Robertson 2823 W TImber Creek Dr Wichita, KS 67204 .

Dentist

10/05/11 Ned Tooorov 2951 N Governor SI #209 Wichita; ks 67226

Dentist

10105/11 Jason Wagle 2844 N Cypress Ct WichilE!. KS. 67226

Dentist

10105/11 Marquez Sams

. 9911 E 21st St N #606 Clearwater, KS 67026' .

Deiltist

10105/11 Brett Rauls 416 Allison St. NeWlon, KS 67114

Dentist

Hal Hale 10105/11 _ 1247 Bracken Ct

. Wichita. KS 67206

. Dentist

10105111 Robert Beaver 12294 SW 84 Andover, KS 67002

- Dentist

10/05/11 Margret Anne Detmer B404 W 13th St #200

. Wichita, KS 67212

Dentist

10/05/11 Kevin Christensen 15 Stagecoach Cl Wichita, KS 67230

De·nlist . /

10105/11 Michael Jacobsen 112 E Kerry Lynn Dr Andover, KS 67002

Dentist

b""",,~.,.,.,.,~

Amount ofCheck Appropriate Box Casb, Cheek,

Cuh Cbf

P.005(016 (FAX)316 265437901/05/2012 15:18 Physicians Development Group

SCBEDULEA . CONTRIBUTIONS AND OooR RECElPTS

Phil Hermanson (Name of Candidate)

Occupation & Industry or Name and Address Individual Giving More

Date ofContributor Tbun $lS0'

Check . Amount or Appropriate Box Cash, Check,

1--+':"-";"'-...,...--.--, LoaD 01' Other CIlJh

Cberk Loan ~~:~ Receipt

10/05/11 Cynthia Sherwood 308 N 6th St Independence, KS 67301

Dentist

1 $100.'00

10/05/11 Steve Rohr 1307 Rutland Circle Wichita, KS 67206

Dentist

1 $250.00

10/05/11 J.. Kendall Dillehay 1040 N 143 SI. E Wichita, .KS 67230

Dentist $50."00

10/05/11 Dr. Antolns'E Waklm 33 Rolling Hills Wichita, KS 6212

'Dentist 1 $100.DO

10/05/11 Dr. Dexter Woods 2909 N. Oliver 5t #1012A Wichita, KS 67220

Dentist

1 $100.00

-:-".

10/05/11 Fermers Employees & Agents PAC 8018 W 113th Terrace Overland Park,-KS 66210 '

PAC

10/05/11 Kansas Dental PAC 5200 siN Huntoon 5t Topeka, KS 66604

PAC

10/05/11 Cox Communications 901 S George W~shington Wichita. KS 67211

Blvd Media Company

10/05/11 All Stale Insurance Co PAC 2775 Sanders Rd. Sle A5 . Northbrook. 1160062

PAC

10/05/11 Weststar Energy Slate PAC PO Box 889 Topeka, KS 66601

PAC

$500.00

,I

$500.00

$250.00 .

1

$200.00

$250.00 .

Exxon Mobile Corp. Oil·& Gas Co. 10/05/11 POBox 2519 $;300.00

.' Houston, TX 77252-2519

~1ff~t~~".;::~:~~~~:-:7~1.::±:i.. w:~_·~:rj;""~·""'···"7·'1% .. ,""·· $2,600.DO

Pl\gc~of__

(FAl0316 265 4379 P.OOSJ01S ·01/05/2012 15:18 Physicians Deveiopment Group

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Phil Hennanson

.(Name of Candidate)

AmOUllt of Nome and Address

Occupation & Industry of Check Ca!b. Check, ,. ~

Date Individual Giving Mllrc App,ropriatc Box

, Loan· or Other·Thlln $150 of Contributor CASh

Chuk LoaD r~;;:,:' Receipt

PepsiCo Beverages Soft Drink Co. 11/08/11 555 W Monroe St Ste 16-2 $250.00.;

~.

Chicago, II 60662

. Kansas Health Care Assn. PAC PAC 11/08/11 ·117 SW 6th Ave Sle 200 $500.00

Topes. KS 66603

Kansas Beverage Assn PAC PAC 11/21/11 $250.00

Jopeka, KS 66614' .

Kansas Nurse Anesthetists PAC

5845 SW29lh St

PAC 11/21/11 10437 W 125th Terrace .; .$150.00

Overland Park, KS 66213.

FamIly Health & Rehab Assisted Living Center 11/21/11 _ 639 SMaize Rd $500.00

Wicliita: KS 67209

BNSF Railway Co

.; Railroad Co

11/21/11 2500 Lou Menk Dr. AOB·3 ., \ Fort Worth, TX 76131

Kansas Restaurant & Hosp. PAC PAC 11/21/11 3500 N Rock Rd Bldg 1300

$300.00

$250.00 WIchita, KS 67226 ,

Kansas Credit Union LAC LAC Legislation Action 11/21/11 .; $200.00

Topeka. KS 66612 .

, Prairie Band Potowatomi Nation Casin

P.007/016(FAX)316 265 43~90110512012 1-5:18. Physicians Development Group

SCHEDULE A CONTRmUTIONSANDOTHERRECEFTS

Phil Hermanson

(Name ofCllDclidnte)

Check Amount of Name and Address

Oceupntlon & Industry of Appropriate flox Casn, Check,

Date Individunl'Giving More

t--....------r--,-----j Loan or Other Cub

of Contributor Than $150 Cbm Loo" E tIlnd.

Olb.r Receipt

Loan Max LM167 'Loan Company 12/07/11 3601 S. Topeka Blvd. $250.00

Topeka. KS. 66611

Kansas Cable PAC PAC 1'f107/11 $200.00815 SW Topeka Blvd. 2nd Floor

Topeka, KS 66612

RAI SerVices Electric & Construction 12107/11 PO Box 464 .;. $200.00Company

Winston-Salem, NC 27102

T-Mobile Phone Company $200.00

Bellevue, WA 98006 12107/11 12920'SE 3Bth 51

'I pAcKS S~te'Farm Insurance PAC 12107/11 825 S. Kansas Ave Ste.50a $250.00

Topeka,KS.66612

Wesley Medical Center HCA Hospital 12/28/11 550 N Hillside $250.00 I

Wichita, KS 67214-4976

Midwest Energy Inc. Energy Producer 12/28/11 1330 Canterbury Drive PO 898 $2.00.00

Hays, KS 67601-0898 .

.Sprint Nelde! Phone Company 12/28/11 PO 80x 63670 $200.00

Phoenii:; AZ. B5082·3670

·KOCH . Energy and Utilities 1212'8/11 4111E 37th St. N . Si500.00

Wichita, KS' 87220

MEldeo Health Solutions. INC. Health Consultants J 12/28/11 $100.oq10P Parsons Pond Drive

Franklin Lakes, NJ 07417-2603

" Kansas REALTORS PAC' PAC ,$500.0012/28/11 3644 S Burlingame Rd.

Topeka.KS 65611.

$2,850.00

. Page 6' of__

01105/2012 15:18 Physicians Development Group (FA}()316 265 4379 P.ODS/016

.'

Phil Hermanson.

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate)

Name and Address Date of COli tributor'

Kansas Assoc. of Health Plan PAC 12128111 825 5 Kansas Ave 5te 502

Topeka, KS 66612

. Time Warner Cable 12/28/11 7800 Crescent Executive Dr.

Charo/elte, NC 2821.7

American Family Insuance-KS PAC 12/28/11 1300 WArrowhead Rd.

Topeka, KS 66604-4019

Next Era Energy Resouces LLC . 12/28/11 700 Universe Blvd..

Juno Beach,FL, 33408

Walgreens 12/28/11 . 104 Wilmot Rd MS # 1444

. Deerfield, IL Boo15

Kansas Physical Therapy Assoc. 12/28/11 2900 5W Plass.Ct

Topeka,KS 66611

Kansas Automobile Dealers EAC EAC- Election Action 12128/11 731 S. Kansas'Ave Committee ::..

Topeka, KS: 66603-3807

Sunflower Electric.Power Corp. Power Supply Company _12/28/11 301 W 13th 5t; PO Box 1020

HayS, KS. 67601

Kansas Chamber of Commerce PAC 12/28/11 835 SW Topeka Blvd

Topeka, KS 66612-1671 (

Phil Hermanson . Reimbursement 12/29/11 ·5~3B·S. Mosley

Wichita, /($ 67216

Enterprise Holdings, INC. pAc PAC -12/26/11 600 Corporate Park Drive

St Louis, MO 63105

OccopatioD & Industry of Individual Giving More

ThaD $150

PAC

Cable TV Company

PAC

Developer & owner of power plants

Pharmacy

PAC

ClUh

Check Appropriate Box

ClInk

""Ii.

Loin E fundI '"OibU"

Amount of Cash, Check,

LOlllI or Otber Receipt

$200.00

$200.00 .

·$250.00

$250.00

$200.00

$200.00

$200.00

$500.00

, $112.67

$200.00

$2,562.67

pa~e~Of__

0110512012 15:18 Ph~'Sicians Development Group (FA){)316 2654379 P.009J016

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Phil Hermanson. (Name of Candidate). .

Name nod Address Dnte of Contributor

Occupation & industry of -Individual Ginng More

TbaD $150

Check Appropriate Dar

Amount of Casb,Chee~

Loan or Other Receipt

C.,b Cb«k LoA. E lund' ()iij';'"

Phil Hennanson 04/18/11 5338 S. Mosley

--lWichita, KS 67216

Loan to Campaign ~ .( $24.44

Swedish Match of NA, INC Cigar Manufacturer 1021 E Cary St. Ste 1600 $200.001.12/30/11 Rluchmond, VA 23219-4000

Complete if last page ofSchedule A

~To_tnl.,-lt_cm_li:_zed_R_~c_e-,-iP_ts_fo_r_P_er_jo_d ----~------__i /6'53 7.1/ Total Unitemized Contributions (:li50 or less)

Sale ofPoliticul Materials (Unitemizea)

.Total Contributions When Contributor Not P'JlOwTI.

rageLof__

I, (FAX)316 26S 437B P,010/016,01/05/2012 15:19 Physicians Development Group

SCHEDULE B

IN-KIND CONTRIBUTIONS

Phil Hermanson

(Name ofCundidatc)

Value ofList OccuputiOD & nate In-Kind'NUIDO lind Address De.criptioD of Iu-KindInd ustry for Thue Giving

Contribution Contributionof Coutribulor lln In-Kind of More Tball '. 5150

Voter File for District 8. aPAC- Small Business Kansas Chamber PAC , $393.00,12/28/11 835 S~ Topeka Blvd, Smart Phone App: for door Advocate and Supporter

to door campaigning.Topeka, KS 66612-1671 '

$393.00

Complete if last page or-Schedule B

Total Itemized (ove~ $100) IIl-K~d Conq.ibulions

Toml Unitemized (S 100 or less) In-Kind Contributions

$393.00

JegeLOf__

I (FAX)316 265 437901105/2012. 15:19 Physicians Development Group rOll JOt6

... . Sc;HEDULE C EXPENDIT.URES AND OTHER DISBURSEMENTS

Phil Hennanson

(Nll1Ile ofCandidate)

Date Name ~Dd Address PurplIse Df Expenditure

or Disbursement

114/11

1/4/11

114111

1/5/11

I Do Bridal 91 B E.. Douglas Wlchlta, KS 67201

Jesse Dyke 10300 W. Maple Wichita, KS 67209

Jesse Dyke 10300 W. Maple Wichita, KS 67-409

Phil Hermanson 5338 S. Mosley. . Wichita, KS 67216

. Campaign Worker

Campaign Worker

Printing Cost

1/5/11 Usa Wisdom. 1394 W.50th Ave N CorywaySprings , is 67031

Campaign Worker

116111 Dan Kerschen 645 S 263rd W ~artlen Plain, KS 67050

1111111 I-Mobile 518 N. Rock Rd

. Wichita; KS 67207

Campaign Phone Bill

1/31/11 Intrust Bank 105 N. Main Wicfiita. KS67201

Bank Service Charge

2/14/11 T-Mobile 518 N Rock Rd Wichfta, KS 67207

Campaign Phone sill

I . $100.00

I I

$20.00

I , $1 Oil.54

I

·1·$106.70

I Intrust Bank Bank Service Charge I

2/?-BI11 105 N: Main $10.00 .' Wichita, KS 67201 I

Kansas Dept of Corrections Frames for Awards 3/2111 gOO Jackson Room 404N

Topeka, ICS 66612

~(f;~1}K~~~~!~.B·~~l~!~i~~J~tlll~~~1;ft~iSi1~~~~;~~~~~;';.~;%:~&~!~~~1t'~;~~~~t~~,:g~~·~~f:~i.1~:;\.i:t~jiKJ

ArnOlDI

$1h2.67

I

+.00 ~ .5.00

.[ . $100.00

·1

\ $60.00I

$69+01

pngeLOf_1

(FAX)316 265 437901/0512012 15:19 Physicians Development Group

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Phil Hermanson

(Name OfCBDdidnte)

\.PurpOliC of Expenditure , Date Dr Dillbl!nement AmountNome and Address

I jSlate of Kar.lsas

3/4/11 $11.00 Topeka, KS 66\312 300 'sw 10th Ave

j jCampaign Phone BillT-Mobile

$105.79 Wichita, KS 67207

3/18/1',1 5113 N Rock Rd

il Intrust Benk Banl\ Service Charge

'3131111 105 N Main Wichita,K;S 67201

Bank Service Charge 4/30/11

1lJ.lrust Bank 105 N Main Wichita, KS 67201

jBank Service Charge, Intrust Bank $10.00

Wichita, KS 67201 5/31111 105 N. Main. .

.1 I

Repair & Seal Custom 4x8 Campaign Sign 'David McLain • l .1 6/22/11 '111 mOt1(J.. CII-r.c, #1 $45.00

Wichita; KS 67216 1 J

Campaign Phone Bill T-Mobile . ~, 6/24/11 51 s' N. Rock Rd ' $101.35

1Wichita, KS 67207 , ~Bank Service Charge Intrust Banl\ .

$18.00 ,Wichita, KS 6720'1

6/30/11 105 N Main

I \ '

7/5/11 5338 S Mosley Postage,Phil'Hermanson '

$50.00 , 1 Wichlta,KS 57216 !

1

jWichita Wagonmaslers 'Non-profit Mens group Annual Dues I

7/B/11· PO 6())( lIalo , $450.00 J

: Wichita, KS 6.1201'- HO(p I

Mike Plmer Caf!lpalgn Website Developer -' I ' $300.007/11/11 ~ 10229 Milestone Drive #31 02

Lenexa, KS 66220 1

'PUgC ~ of_1'

(FAX)316 265 4379 J.013f01601105/2012 15:19 PhysiCians Development Group

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Phil Hermanson (N orne of CODdidatc)

Purrose ofExpCDditul'C Dr DiJbarscnlcotDate ND!'IC alld Address

r. 0_

7/18/11 "T-Mobii~'~:' ... Campaign Phone Bill !

$101.29518 N Rock Rd ! 'Wichita, KS 67207 Member Dues for non-profit Mens Club East·Mens YMCA Club I

$125.007/22/11 9333 E Douglas Wichita, KS 67207 I

\Cost for research ~nd printing out Intrust Bank 7/25/11 $41.60 .I statements and checks ,105 N: Main

. Wichita., KS 67201

Phil Hermanson Food & Drinks Campaigning 7/26/11 / 5338 S. Mosley $50.00

Wic;hita,KS 97216

Intrust Bank Bank Service Charge 7/31/11 105 N Main

Wichita, KS 67io.1 .

Phil Hermanson 8/5/11 ·5338 S.Mosley

Wichita; KS 67216

T-Mobile: 8/15/11 518 N Rock Rd

WlchitYa, KS 67207

David Mclain . Cfl7Jv1ono, C\~I~.

. W~chita, j

P.014/01601/05/2012 15:19 Physicians Development ~roup (FAX)3162654379

SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Phil Hermanson (Name ofCundidolc)

Date Name and Address I'urp08e of Expenditure

or D/sbu rselllcnl Amount

8/31/11 Intrust Banl( 105 N Main Wichita, KS 6'7201

Bank Service Charge -$10.00

9/9/11 Phil Hermanson 5338 S. Mosley Wichita, KS 67216

Campaign Food & Drink; fundraising letters stuffed and labeled $50.00

9/12/11 Phil Hermanson 5338 S. Mosley wichita, KS 67216

CampaIgn Food & Drink; fundraising letters stuffed and labeled. $50;00

9/14/11 Phil Hermanson 5338 S. Mosley Wichita, KS 67216

Campaign Food·& Drink; fundraising letters stuffed and labeled $50.00

9/14/11 Phil Hermanson 5338 S. Mosley Wichita, KS 67216

Postage $50.00

9/20/11 Phil Hermanson ?338 S. Mosley Wichita, KS 67216

Po~tage $100.00

9/21/11 T-Mobile 518 N Rock Rd Wichita, KS 67207

Campaign Phone Bill $100.47

9/30/11 Intrust Bank 105 N Main Wichita, i

-- --

(FAX)316 265 4379 P.015/01601/05/2012 15:19 Physicians Development Group

SCHEDULEC EXPENDITURES AND OTHER-DISBURSEMENTS

Phil Hermanson

(Name of Condidote)

'\

Purpose of Expendt'ture Date Nome ond Address or Disbursement

Phil Hermanson Thank yous and postage 11/8/11 5338 S Mosley

Wichita, KS 67216 '

'Deluxe Checks Checks-Campaign Accl., .' 11/8/11 200 Riverside Ind. PkWy

Portland, ME 04103

T-Mobile Campaign' Phone 811 11(14/11 518 N. Rock Rd

Wichita, KS 67207

Office MaX. Ink Cartridges for Campaign Printer ,11/22111 6940 W. Kellogg

Wichita, KS 67209

.Ric,h flUftles 2" coolers for Campaign 11/22/11 6432 E 34th St N #110

Wichita, KS 67205 -

Kansas Republican Party RHCC Dues Donation to RHCC 11/28/11 . PO Box4157

Topeka, KS 66604

South Wichita YMCA Donation to YMCA Strong Kids of KS. 11/29/11 34q5 S, M'eridian Ave '

Wichita, KS 67217

OffiCe Depot Computer privacy Screen 11/30/11 613 S. Dugan R,d. Ste. 100 .

Wichrta, K~ 67209

i-Mobile Campaign Phone Bill 12/7/11 51 B'N. Rock Rd.

Wichita, KS ,67207

Walgreens ' stamps & ThBn~ yous 1217/11 2229, N Maize Rd.

, Wichita, KS 67212

12119/11· L & S Homebuyers Printing services and final postage bill 7200 W. 13th St Ste 5 ,WichIta, KS. 67212

Amount

$50.00

$33.20

,$100A2

$66.22

$40.00

$500.00

$500.00

$45.06

$102.47

$39.25

$2.76.50

$1,75q.12

. ,

Pege )3 of

01105/2012 15:19 Physicians Development Group (FAX)316 2654379 P.01S/01S

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Phil Hermanson ( Name OfClUldidllte)

Intrust Bank 12-29-11 1aS N. Main

Wichita. I