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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
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(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
__'
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(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
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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__
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(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
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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.
$2,850.00
. Page 6' of__
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01105/2012 15:18 Physicians Development Group (FA}()316 265 4379 P.ODS/016
.'
Phil Hermanson.
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
(Name of Candidate)
Name and Address Date of COli tributor'
Kansas Assoc. of Health Plan PAC 12128111 825 5 Kansas Ave 5te 502
Topeka, KS 66612
. Time Warner Cable 12/28/11 7800 Crescent Executive Dr.
Charo/elte, NC 2821.7
American Family Insuance-KS PAC 12/28/11 1300 WArrowhead Rd.
Topeka, KS 66604-4019
Next Era Energy Resouces LLC . 12/28/11 700 Universe Blvd..
Juno Beach,FL, 33408
Walgreens 12/28/11 . 104 Wilmot Rd MS # 1444
. Deerfield, IL Boo15
Kansas Physical Therapy Assoc. 12/28/11 2900 5W Plass.Ct
Topeka,KS 66611
Kansas Automobile Dealers EAC EAC- Election Action 12128/11 731 S. Kansas'Ave Committee ::..
Topeka, KS: 66603-3807
Sunflower Electric.Power Corp. Power Supply Company _12/28/11 301 W 13th 5t; PO Box 1020
HayS, KS. 67601
Kansas Chamber of Commerce PAC 12/28/11 835 SW Topeka Blvd
Topeka, KS 66612-1671 (
Phil Hermanson . Reimbursement 12/29/11 ·5~3B·S. Mosley
Wichita, /($ 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__
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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__
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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__
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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
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(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'
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(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
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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
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(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
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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