R C.I KANSAS GOVERNMENTAL ETHICS Ethics 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. only jf appropriate: Amended Filing __ Tennination Report L C. Summary the period from January 1,2017 through December 31,2017) 3523.15 I. Cash on hand at beginning of period , . 4930.00 2. Total Conti"ibtltions and Other Receipts (Use Schedl.i1e A) . 8453.15 3. Cash available this period (Add Lines 1 and 2) d .. 7401.12 4. Total Expenditures aod Other Disbursements (Use Schedule C) , .. 1052.03 5. Cash on hand at close ofpetiod (Subtract Line 4 from 3) , . 0.00 6. In-Kind Contributions (Use Schedule B) .r ....... 0.00 7. 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
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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