rece~tsandexpendituresreport filed of...

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECE~TSANDEXPENDITURESREPORT

OF A CANDIDATE FOR STATE OFFICE

October 29, 2012

FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS

FILED

OCT 29 2012

KRIS W. KOBACH SECRETARY or: STATE

A. Name ofCandidate: _A_n_n_E_._M_a_h _

Address: 3351 SE Meadowview Dr

City and Zip Code:_To_p_e_k_a_6_6_6_0_5 _ County: Shawnee

Office Sought: State Representative District: 54 -----

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

C. Summary (covering the period from July 27, 2012 through October 25,2012)

1. Cash on hand at beginning of period . $15,118.95

2. Total Contributions and Other Receipts (Use Schedule A) .. $19,655.00

3. Cash available this period (Add Lines 1 and 2) . $34,773.95

4. Total Expenditures and Other Disbursements (Use Schedule C) .. ($281446.62)

5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . $6,327.33

6. In-Kind Contributions (Use Schedule B) $172.50

7. Other Transactions (Use Schedule D) $71789.75

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. 1 understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."

10/29/12 Date Signature ofCandidate or Treasurer

GEe Form Rev, 2001

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Ann E Mah (Name of Candidate, Party Committee or Political Committee)

Date

7I1.m.012

811.11.012

81311.012

8/611.012

8n11.012

811.311.012

811.311.012

811.411.012

811.811.012

9/411.012

9/511.012

9/611.012

9n11.012

9/1111.012

Oceupation & Industry Cbeek

Name aud Address A ro riate Box of Contributor

ofIndividual Giving EfundsMore Tban $150 Casb Cbeek Loan Otber

Little Government Relations LLC 800 SW Jaekson St Ste #914 0 181 0 0 Topeka, KS 66612-2214

Marjorye S Heeney 100 SE 9th St #708 0 181 0 0 Topeka, KS 66612-1219

Laborers Local Union #1290 PAC, 2600 Merriam Ln 0 181 0 0 Kansas City, KS 66106

Shawnee Co. Deemocratic Legislative Committee 0 181 0 0 PO Box 2571, Topeka, KS 66601

Anheuser Busch Companies One Busch Place 0 181 0 0 StLouis,MO 63118

Kansas National Education AssocPAC, 715 SW 10th 0 181 0 0 Topeka, KS 66612-1686

Duane Johnson 4142 SE29th St 0 181 0 0 Topeka, KS 66606

Michael Blumenfeld 2713 Westdale Cir 0 181 0 0 Lawrence, KS 66049

Micheline Z Burger 26622 W Greentree Ct 0 181 0 0 Olathe, KS 66061

Jack Strukel 5125 SE 10th St 0 181 0 0 Tecumseh, KS 66542-9427

Marjorye S Heeney 100 SE 9th St #708 181 0 0 0 Topeka, KS 66612-1219

DarreU Timken 3418 SE Buckeye St 0 181 0 0 Topeka, KS 66605

Robert S Maxwell 2333 SW Mayfair PI 0 181 0 0 Topeka, KS 66611

H Edward Quick, Jr 503 Arizona St Retired 0 181 0 0 Lawrence, KS 66049

Amonntof Casb, Cbeek,

Loan or Otber Reeeipt

$100.00

$100.00

$500.00

$500.00

$200.00

$500.00

$100.00

$100.00

$100.00

$100.00

$20.00

$100.00

$75.00

$250.00

$2,745.00

Page 1 of 12



Check Name and Address ro riate Box

Date of Contributor E funds

Cbeck Loan Otber

Sarah M Casad 911112012 1130 Emery Rd III [J [J

Lawrence, KS 66044-2515

Randall Jay Roy 911112012 1561 SW Lakeside Dr III [J [J

Topeka,1CZS 66604-2529

Richard B Hanger 911112012 3575 Shoreline Dr III [J [J

Topeka, KS 66605

Frank C Sabatini Trust 911112012 2423 SE 37th St III [J [J

Topeka, KS 66605-2310

KS AFL-CIO - Cope Fund 9/1312012 2131 SW 36th St III [J [J

Topeka, KS 66611-2553

Kansas Sierra Club PAC 9/1312012 5240 Decatur Rd III [J [J

Meriden, KS 66512

Capital Area Federation of Women's 9/1412012 Democratic Club, 5131 SW 33rd Terr, III [J [J

Topeka, KS 66614

Dan Watkins 9/1412012 901 New Hampshire #200 III [J [J

Lawrencs,KS 66055

James M Gartner 9/1912012 928 SW Woodbridge Ct III [J [J

Topkea, KS 66606

DCP Midstream, LP 9/1912012 370 17th St, Ste#2500 III [J [J

Denver, CO 80101

Lynn Hellebust 9/1912012 1516 SW Boswell Ave III [J [J

Topeka, KS 66604

Rick Stein 911912012 963 N 1950Rd III [J [J

Lawrence, KS 66049

Marvin Hornbostel 9/1912012 3707 Hwy K244 III [J [J

Junction City, KS 66441

Teamsters 696 DRIVE for Kansas 912012012 3600 NE Sardou Ave Bldg #1 III [J [J

Topeka, KS 66616

Amount of Casb, Cbeck,

Loan or Otber Receipt

5100.00

5250.00

5100.00

5200.00

$300.00

$SOO.OO

5150.00

5100.00

5150.00

$300.00

5100.00

5100.00

5100.00

5500.00

52,950.00

Occupation & Industry of Individual Giving

More Tban 5150

Retired

Retired

Consultant 1 Telecommunications

Casb

[J

[J

[J

[J

[J

[J

[J

[J

[J

[J

[J

[J

[J

[J

A

Page 2 of 12



Occupation & Industry Check Amouotof

Name and Address Ap ro riate Box Cash, Check, Date

of Contributor of Individual Giving

Efunds Loan orMore Than 5150 Cash Check Loan

Other Other Receipt

William R Brady 912012012 1235 Stone Creek Dr [J III [J [J $100.00


NEA - Topeka PAC 912012012 715 SW 10th Ave [J III [J [J $100.00

Topeka, KS 66612-1617

Jolene C Miller Corporate Executive I

912012012 3309 SE Tomahawk Ct [J III [J [J $150.00

Topeka, KS 66609 Transportation

Nancy W Irwin 912012012 1540 SE 93rd St [J III [J [J $100.00

Wakarusa,KS 66546-9257

Mary M Thomas 912012012 3511 SE Tomahawk Ct [J 1m [J [J $100.00

Topeka, KS 66605

Zandra L Myrick 912012012 5831 SW 22nd Terr #1 [J III [J [J $100.00

Topeka, KS 66614

Kathleen A Selig Physical Therapist I

912012012 5601 SE Ratner Rd [J 1m [J [J $200.00 Berryton,KS 66409

Medical

Stephen N Six 912112012 1131West HiDs Pky [J 1m [J [J $100.00

Lawrence, KS 66044

United Steel Worken Local 307 912112012 Legislative Fund, 1603 NW Taylor [J 1m [J [J $250.00

Topeka, KS 66608-1556

Byron E Springer 912212012 POBox 666 [J 1m [J [J $100.00

Lawrence, KS 66044

Kansas Contractors Assoc 912212012 PAC, 316 SW 33rd St [J 1m [J [J $250.00

Topeka, KS 66605~061

United Transportation Union PAC 912212012 3741 SW Kings Forest Rd [J 1m [J [J $250.00

Topeka, KS 66610

Donald C Signor Retired I Spouse:

912512012 248N850Rd [J 1m [J [J $200.00 Overbrook, KS 66524

Retired

Marilyn H Tilghman 912512012 1602 Brandon Woods Ct [J 1m [J [J $100.00


$2,100.00

Page 3 of 12


Ann EMah (Name of Candidate, Party Committee or Political Committee)

Occupation & Industry Cbeck Amount of

Name and Address A ro riate Box Casb, Cbeck,Date of Contributor

of Individual Giving Efunds Loan or

More Tban $150 Casb Cbeck Loan Otber Otber Receipt

Harry G. MiUer 912612012 345 Mississippi [] 1m [] [] $100.00

Lawrence, KS 66044

Jean F Shepherd 912612012 3416 Riverview Rd [] 1m [] [] $100.00


Kansas Optometric PAC 912612012 1266 SW Topeka Blvd [] 1m [] [] $250.00

Topeka, KS 66612

Carolyn J Crawford 912612012 834 Hwy40 [] 1m [] [] $100.00

Lawrence,KS 66049-4173

Abbie P Hodgson 912612012 2028 New Hampshire St [] 1m [] [] $100.00


Tess Banion 912612012 505 Rockledge 1m [] [] [] $60.00

Lawrence, KS 66044

Kansas Funeral Directors Assoc 912812012 PAC, 1200 Kansas, Topeka, KS [] 1m [] [] $150.00

66612

Herman Page 912812012 POBox 5167 [] 1m [] [] $100.00

Topeka, KS 66605-0167

Local 1445 Carpenters PAC 912812012 212 NW Norris St [] 1m [] [] $500.00

Topeka, KS 66608-1355

Betty M Tudor 912812012 900 SW 31st St #239 Retired [] 1m [] [] $100.00

Topeka, KS 66611

Robert R Resnik 912912012 3641 SE 27th St [] 1m [] [] $100.00

Topeka, KS 66605-1960

GKCWPC Separate Segregated 10/112012 Fnnd, PO Box 10095 [] 1m [] [] $100.00

Kansas City, MO 64171

Plumbers & Pipefitters Local 101312012 Union #441, 1330 E 1st #115 [] 1m [] [] $500.00

Wichita, KS 67214

Kansas State Troopers PAC 101312012 1200 SW 10tb Ave [] 1m [] [] $250.00

Topeka, KS 66604

$2,510.00

Page 4 of 12



Occupation & Industry Check Amount of

Name and Address A ro nate Box Cash, Check. Date

of Contributor of Individual Giving

Efunds Loan orMore Than $150 Cash Cbeck Loan

Other Other Receipt

Micbael W Goodwin 1013/l012 3819 SE 31st St [] 1m [] [] $100.00

Topeka, KS 66605-2109

KS State Farm Insurance Agents 1013/l012 & Employees PAC 825 S Kansas [] 1m [] [] $100.00

Ave #SOO, Topeka, KS 66612

International Assoc of Fire 10/4/l012 Fighten #83, 318 SE Jeffenon [] 1m [] [] $500.00

Topeka, KS 66607

Howard A Duncan Corporate Executive /

10/4/l012 3320 SE 37th St [] 1m [] [] $150.00 Topeka, KS 66605

Recreation Industry

Pat Laugblin 10/6/l012 3100 SE Burton [] 1m [] [] $100.00

Topeka, KS 66605

Kansas Dental PAC 10/6/l012 5200 SW Huntoon St [] 1m [] [] $250.00

Topeka, KS 66604

Justin A Hoover Pbysical Tberapist /

10/6/l012 604 N Spring Valley Rd [] 1m [] [] $500.00 Junction City, KS 66441

Medical

KTLA Consumer/Civil Justice 1018/l012 PAC, 719 SW Van Buren [] 1m [] [] $500.00

Topeka, KS 66603

Elizabeth H Scott 10/13/l012 3435 SW Alameda Dr [] 1m [] [] $100.00

Topeka, KS 66614

Glass House Liquor 10/13/l012 2301 Wakarusa Ste C [] 1m [] [] $125.00

Lawrence, KS 66047

Western MO & KS Laborers' Dist 10/13/l012 Council PAC, 1101 E 87th #100 [] 1m [] [] $500.00


District #70 MNPL, PA 10/13/l012 3830 S Meridian [] 1m [] [] $500.00

Wicbita, KS 67217-3704

Heavy Constructon Assn PAC 10/13/l012 3101 Broadway Ste #780 [] 1m [] [] $200.00


Kansas Health Care Assn PAC 10/13/l012 117 SW 6th Ave Ste #200 [] 1m [] [] $250.00

Topeka, KS 66603-3840

$3,875.00

Page 5 of 12



Occupation & Industry Check Amount of

Name and Address A ro riate Box Cash, Check, Date

of Contributor oflndividual Giving

Efunds Loan orMore Than $150 Cash Check Loan

Other Other Receipt

AT&T Kansas PAC 10/1612012 220 E 6th Rm ##500 [] 181 [] [] $500.00

Topeka, KS 66603

American Family Insurance 10/1612012 Kansas PAC, 1300 SW [] 181 [] [] $100.00

Arrowhead, Topeka, KS 66604

Phil Ruffin Investor /

10/1712012 POBox 17087 [] 181 [] [] $200.00 Wichita, KS 67217

Real Estate

By-Vee Inc 10/1712012 5820 Westown Parkway [] 181 [] [] $250.00

West Des Moines, IA 50266

IBEW PAC Educational Fund 10/1712012 900 Seventh St NW [] 181 [] [] $500.00

Washington, DC 20001

Betty M Tudor 1011912012 900 SW 31st St #239 Retired [] 181 [] [] $100.00

Topeka,KS 66611

Summit Strategies Group, LLC 1012012012 POBox 1342 [] 181 [] [] $100.00

Topeka, KS 66601

Steven R Magee 1012012012 454 E 137th St [] 181 [] [] $100.00

Carbondale, KS 666414

Operating Engineen Local 101 PAC 1012012012 6601 Wmchester Ste 280 [] 181 [] [] $200.00


Kansas State Industrial Union 1012512012 Council, 1603 NW Taylor [] 181 [] [] $200.00

Topeka,1CS 66608

$2,250.00

Total Unitemized Contributions ($50 or less)

Total Unitemized Contributions ($50 or less)

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known

TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary)

$16,430.00

$3,225.00

$0.00

$0.00

$19,655.00

Page 6 of 12

SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS


Date Name and Address Purpose of Expenditure

Amount or Disbursement

AnnMah Reimbursement to candidate for

713012012 3351 SE Meadowview Dr postage $90.00

Topeka, KS 66605


81312012 3351 SE Meadowview Dr office supplies $89.84

Topeka,KS 66606

Econ-O-Print 8/14/2012 4140 SW Martin Dr Postcard printing $247.32

Topeka,KS 66609


8/15/2012 3351 SE Meadowview Dr postage $90.00 Topeka, KS 66606

Neal Resources 8/1712012 17520 Nature Walk Trail #106 Website design $295.20

Parker, CO 80134-5264

AnnMah 8120/012 3351 SE Meadowview Dr

Reimbursement to candidate for $116.91

Topeka,KS 66606 postage & office supplies

AnnMah Reimbursement to candidate for 8/20/012 3351 SE Meadowview Dr office supply donation to Washburn $14.17

Topeka,KS 66606 Auburn Schools

AnnMah Reimbursement to candidate for 8/20/012 3351 SE Meadowview Dr Topeka Aids Projetct Auction! $48.10

Fundraiser

Econ-Q-Print 8124/2012 4140 SW Martin Dr Yard signs & wires $2,586.47

Topeka,KS 66609



Topeka,KS 66606 postage



Topeka, KS 66607 office supplies

AnnMah Reimbursement to candidate for 8129/2012 3351 SE Meadowview Dr Life House Child Advocacy Center $40.00

Topeka, KS 66608 FundraiserlDonation

$3,845.99

Page 7 of 12

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS




Shawnee County Democrats 8/30/2012 1301 S Kansas Ave Donation $250.00

Topeka,1(S 66611

Neal Resources 813012012 17520 Nature Walk Trail #106 Website design $35.00

Parker, CO 80134-5264

Auburn Lions Club 8/3012012 9615 SW Auburn Rd Advertisement $225.00

Wakarusa, I(S 66546

AnnMah Reimbursement to candidate for 8/3112012 3351 SE Meadowview Dr NAACP banquet fundraiserl $73.00

Topeka,1(S 66606 donation, and advertisement


9/4/2012 3351 SE Meadowview Dr postage and parade candy $142.13

Topeka, I(S 66607


9/512012 3351 SE Meadowview Dr postage and office supplies $109.86 Topeka, I(S 66608


917/2012 3351 SE Meadowview Dr office supplies $32.67 To ka, I(S 66609


917/2012 3351 SE Meadowview Dr $25.92 To eka,1(S 66610

candy

Cumulus Broadcasting 917/2012 825 S Kansas Ave Radio advertising $50.00

Topeka,1(S 66612


9/1312012 3351 SE Meadowview Dr office supplies $8.29

Topeka, I(S 66607

AnnMah Reimbursement to candidate for 9/1312012 3351 SE Meadowview Dr Combat Air Museum RunlWalk $50.00

WmWRadio 911312012 1210 SW Executive Dr Radio advertising $49.30

Topeka,1(S 66615

Osage Co Herald-Chronicle 9/18/2012 527 Market St Advertisement $147.50

Osage City, I(S 66523

SI,198.67

Page 8 of 12




Amount or Disbunement


9123/2012 3351 SE Meadowview Dr office supplies 5109.97

Topeka, KS 66607

AnnMah 9/23/2012 3351 SE Meadowview Dr Fundraiser refreshments 520.57

Topeka,KS 66607

Econ-O-Print 9/2412012 4140 SW Martin Dr Mailer printing & postage 52,961.27

Topeka,KS 66609

Osage Co Herald-Chronicle 9/26/2012 527 Market St Advertisement 5296.25

Osage City, KS 66523

Friends of the Topeka Zoo 9/2412012 635 SW Gage Blvd FundraiserlDonation 575.00

Topeka, KS 66606

Econ-O-Print 9128/2012 4140 SW Martin Dr Mailer printing & postage 53,508.50

Topeka,KS 66609

Econ-Q-Print 10/5/2012 4140 SW Martin Dr Mailer printing & postage 52,562.31

Topeka,KS 66609

Osage Co Herald-Chronicle 10/5/2012 527 Market St Advertisement 5296.25



Reimbursement to candidate for 5160.00


AnnMah 10/6/2012 3351 SE Meadowview Dr

Reimbursement to candidate for 539.95

ToPeka, KS 66606 email service

Econ-O-Print 10/9/2012 4140 SW Martin Dr Postcard printing & postage 52,562.31

Topeka,KS 66609

Osage Co Herald-Cbronicle 10/912012 527 Market St Advertisement 5600.00


513,192.38

Page 9 of 12



$74.69 $28,371.93

$10,134.89

Total Itemized Ex enditures This Period Total Unitemized Ex enditures of $50 or less



Econ-O-Print 10/15/2012 4140 SW Martin Dr Postcard printing & postage $2,638.94

Topeka, KS 66609

WmWRadio 10/1512012 1210 SW Executive Dr Radio advertising $847.88

Topeka, KS 66615


10/15/2012 3351 SE Meadowview Dr postage $45.00 Topeka,KS 66606

Econ-O-Print 10/1712012 4140 SW Martin Dr Mailer printing & postage $1,568.13

Topeka,KS 66609

Postmaster 10/19/2012 Hicrest Station Postage $205.00

Topeka,KS 66605

Kansas Democratic Party 10/1912012 700 SW Jackson #706 Donation $2,500.00

Topeka, KS 66603

Econ-O-Print 101232012 4140 SW Martin Dr Postcard printing & postage $601.53

Topeka,KS 66609

Econ-O-Print 10123/2012 4140 SW Martin Dr Printing set-up $65.37

Topeka,KS 66609

AnnMah 1012412012 3351 SE Meadowview Dr



TeleRoots Technologies Inc 10/2412012 2232 Vermont St Roboc:aUs $137.76

Lawrence, KS 66046

Econ-O-Print 10/25/2012 4140 SW Martin Dr Postcard printing & postage $1,339.28

Topeka, KS 66609

TOTAL EXPENDITURES & OTHER DISBURSEMENT TillS PERIOD to line 2 of Summary) $28,446.62

Page 10 of 12

SCHEDULE B IN-KIND CONTRIBUTIONS


Value ofList Occupation & Industry Description of In-KindName and Address In-Kindfor Those Giving an In-Kind Date Contributionof Contributor Contributionof more than $150

Kansas' Wine & Spirits Wholesalers $172.50Beverages for Fundraiser 9/20/2012 PAC, 212 WS 8th Ave Ste

#202,Topeka,~ 66603

$172.50

Complete if last page of Schedule B

$172.50 $0.00

$172.50

Page 11 Of 12

SCHEDULE D OTHER TRANSACTIONS


Balance atNature of Account or Loan Payable

Close ofName and AddressDate or Loan Receivable Period

AnnMah Account payable to candidate for campaign 10/23/2012 3351 SE Meadowview Dr payment to Osage Co. Herald-Chronicle for $693.75

Topeka, KS 66605 advertising

Econ-O-Print 10/2512012 4140 SW Martin Dr Account Payable for printing, mailing & postage $5,200.00

Topeka, KS 66609

Osage Co Herald-Chronicle 10/2512012 527 Market St Accounts payable for advertising $296.00


Kansas Democratic Party 10/2512012 700 SW Jackson Ste #706 Accounts payable for campaign services $1,000.00

Topeka, KS 66603

KTPKRadio 10/2512012 1210 SW Executive Dr Accounts payable for advertising $600.00

Topeka, KS 66615

$7,789.75

Complete if last page of Schedule D

$7,789.75

Page 12 of 12

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