Generated On: 1/15/2008 1:15:34 PM

Schedule A: Contributions Sch-A

Iowa Health PAC Status: Amended
Committee Type: Iowa PAC Statutory Due Date 10/19/2004

County: NA Adjusted Due Date

District: 0 Filed Date 10/23/2004

Committee Code: 6067 Postmark Date

Political Party: Not Available Amendment Date 11/15/2004

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
7/15/2004 Check # Ferrell, Connie None $0.00
5463 2096 155th St.
Fairfield, IA 52556
7/15/2004 Check # Durbin, Corey None $0.00
3280 1034 Flair Court
St. Louis, MO 63146
7/23/2004 Check # Olivo, John None $500.00
6290 195 N. Harbor Dr. #4506
Chicago, IL 60601
7/23/2004 Check # Chartier, Jeanine None $200.00
5688 2065 Hwy 20
Lawton, IA 51030
7/23/2004 Check # Webb, Kenneth None $1,000.00
5247 21688 N. 81st St.
Scottsdale, AZ 85255
7/23/2004 Check # Wymore, Linda None $122.50
1466 2119 Taylor Page Avenue
New Market, IA 51646
8/9/2004 Check # Morris, Connie None $7.11
301 E. Main
Garden Grove, IA 50103
8/9/2004 Check # Dowling, James None $9.00
201 Grant
Bedford, IA 50833
8/9/2004 Check # Robinson, Bill None $8.40
223 Myrtle
Creston, IA 50801
8/9/2004 Check # Dudycha, Kay None $6.30
211 Pike Rd.
Ottumwa, IA 52502
8/9/2004 Check # Harvey, Lori None $3.60
702 14th Street
Corning, IA 50841
8/9/2004 Check # Proctor, Mary None $50.00
4756 3105 EP True Parkway #611
West Des Moines, IA 50265
8/9/2004 Check # Greeley, Mary None $14.10
29306 US Hwy 34
Russell, IA 50238

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 6
 Generated On: 1/15/2008 1:15:34 PM

Schedule A: Contributions Sch-A

Iowa Health PAC Status: Amended
Committee Type: Iowa PAC Statutory Due Date 10/19/2004

County: NA Adjusted Due Date

District: 0 Filed Date 10/23/2004

Committee Code: 6067 Postmark Date

Political Party: Not Available Amendment Date 11/15/2004

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
8/9/2004 Check # Allbee, Richard None $1,000.00
5002 P.O. Box 436
Hampton, IA 50441
8/9/2004 Check # High, Robert None $45.00
2546 West 9th St.
Waterloo, IA 50702
8/9/2004 Check # Shirkey, Roberta None $2,000.00
4413 414 W. 2nd St.
Washington, IA 52353
8/9/2004 Check # Brennecke, Dorie None $4.20
7528 13th Avenue
Belle Plaine, IA 52208
8/9/2004 Check # Wollum, Jeff None $8.85
1015 Heartland Hills Dr.
Waterloo, IA 50701
8/9/2004 Check # Spears, Linda None $15.00
2260 Ventura
Rose Hill, IA 52586
8/9/2004 Check # Studer, John None $10.08
1500 Leif Drive
Sioux City, IA 51104
8/9/2004 Check # O'Brien, Leanne None $7.50
3607 Wenig Rd. NE
Cedar Rapids, IA 52402
8/9/2004 Check # Dowd, Steve None $15.00
2136 Terra Lane
Coralville, IA 52241
8/9/2004 Check # Unitemized N/A $2.58

8/9/2004 Check # McDaniel, G.M.(Michael) None $20.00

2733 NW 161st Court
Clive, IA 50325
8/9/2004 Check # Tallman, Pam None $5.52
2770 Fairlane Avenue
Waterloo, IA 50702
8/9/2004 Check # Beaudette, John None $1,000.00
1906 204 SW Carriage Dr.
Ankeny, IA 50021

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 2 of 6
 Generated On: 1/15/2008 1:15:34 PM

Schedule A: Contributions Sch-A

Iowa Health PAC Status: Amended
Committee Type: Iowa PAC Statutory Due Date 10/19/2004

County: NA Adjusted Due Date

District: 0 Filed Date 10/23/2004

Committee Code: 6067 Postmark Date

Political Party: Not Available Amendment Date 11/15/2004

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
8/9/2004 Check # Sandor, Susan None $6.00
818 A Avenue East
Oskaloosa, IA 52577
8/9/2004 Check # Priske, Monte None $8.64
502 12th Street
Eldora, IA 50627
8/20/2004 Check # Voss, Rick None $250.00
117 Fairview Drive
So. Sioux City, NE 68776
8/20/2004 Check # Fena, Donald None $500.00
3968 Box 458
McGregor, MN 55760
8/20/2004 Check # Giorgio, Patricia None $500.00
5955 335 Stoney Creek Rd. NW
Cedar Rapids, IA 52405
8/20/2004 Check # Hampton, Nora None $250.00
1601 66018 E. Stoney Ridge Drive
Tucson, AZ 85739
9/3/2004 Check # Morris, Connie None $4.74
301 E. Main
Garden Grove, IA 50103
9/3/2004 Check # Spears, Linda None $10.00
2260 Ventura
Rose Hill, IA 52586
9/3/2004 Check # High, Robert None $30.00
2546 West 9th St.
Waterloo, IA 50702
9/3/2004 Check # Mortenson, Tim None $250.00
1747 24490 670th Ave.
Nevada, IA 50201
9/3/2004 Check # Brennecke, Dorie None $2.80
7528 13th Avenue
Belle Plaine, IA 52208
9/3/2004 Check # Dowling, James None $6.00
201 Grant
Bedford, IA 50833
9/3/2004 Check # Studer, John None $6.72
1500 Leif Drive
Sioux City, IA 51104

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 3 of 6
 Generated On: 1/15/2008 1:15:34 PM

Schedule A: Contributions Sch-A

Iowa Health PAC Status: Amended
Committee Type: Iowa PAC Statutory Due Date 10/19/2004

County: NA Adjusted Due Date

District: 0 Filed Date 10/23/2004

Committee Code: 6067 Postmark Date

Political Party: Not Available Amendment Date 11/15/2004

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
9/3/2004 Check # Priske, Monte None $5.76
502 12th Street
Eldora, IA 50627
9/3/2004 Check # Wollum, Jeff None $5.90
1015 Heartland Hills Dr.
Waterloo, IA 50701
9/3/2004 Check # Feauto, Jim None $500.00
763 1833 N. Main St.
Carroll, IA 51401
9/3/2004 Check # Harker, Brandie None $1,000.00
2247 2607 Woodland Ave.
West Des Moines, IA 50266
9/3/2004 Check # Robinson, Bill None $5.60
223 Myrtle
Creston, IA 50801
9/3/2004 Check # Greeley, Mary None $9.40
29306 US Hwy 34
Russell, IA 50238
9/3/2004 Check # Dowd, Steve None $10.00
2136 Terra Lane
Coralville, IA 52241
9/3/2004 Check # O'Brien, Leanne None $5.00
3607 Wenig Rd. NE
Cedar Rapids, IA 52402
9/3/2004 Check # McDaniel, G.M.(Michael) None $20.00
2733 NW 161st Court
Clive, IA 50325
9/3/2004 Check # Harkins, Kenneth None $1,500.00
1234 710 Willow Ct.
Solon, IA 52333
9/3/2004 Check # Sandor, Susan None $4.00
818 A Avenue East
Oskaloosa, IA 52577
9/3/2004 Check # Dudycha, Kay None $4.20
211 Pike Rd.
Ottumwa, IA 52502
9/3/2004 Check # Harvey, Lori None $2.40
702 14th Street
Corning, IA 50841

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 4 of 6
 Generated On: 1/15/2008 1:15:34 PM

Schedule A: Contributions Sch-A

Iowa Health PAC Status: Amended
Committee Type: Iowa PAC Statutory Due Date 10/19/2004

County: NA Adjusted Due Date

District: 0 Filed Date 10/23/2004

Committee Code: 6067 Postmark Date

Political Party: Not Available Amendment Date 11/15/2004

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
9/3/2004 Check # Tallman, Pam None $3.68
2770 Fairlane Avenue
Waterloo, IA 50702
9/3/2004 Check # Schott, Donna None $1.72
2016 Augusta Drive
Vermillion, SD 57069
9/15/2004 Check # Strickland, Cheryl None $250.00
5079 11854 Melody Lane
Bridgeton, MO 63044
9/15/2004 Check # Rice, Timothy None $250.00
2381 3707 155th Street
Urbandale, IA 50323
10/1/2004 Check # Johnson, Kelly Jo None $250.00
2107 13416 Ridgeway Drive
Urbandale, IA 50323
10/1/2004 Check # Hageman, Bonnie None $200.00
1998 904 Main Street
Elgin, IA 52141
10/1/2004 Check # Holland, Dana None $20.00
5762 61 Schwartz Dr.
Ottumwa, IA 52501
10/1/2004 Check # Ayers, David None $560.00
3737 1902 Cedar Crest Lane
Charles City, IA 50616
10/1/2004 Check # Rich, Scott None $120.00
4418 633 E. Washington
Washington, IA 52353
10/1/2004 Check # Campbell, Alan None $100.00
2176 4227 Main St.
Elk Horn, IA 51531
10/1/2004 Check # Beeman, Dennis None $100.00
1807 2301 S. Roosevelt
Sioux Falls, SD 57106
10/1/2004 Check # Unitemized N/A $15.00

10/1/2004 Check # Schoening, Neal None $100.00

315 S. Tombergs Dr.
Eldridge, IA 52748

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 5 of 6
 Generated On: 1/15/2008 1:15:34 PM

Schedule A: Contributions Sch-A

Iowa Health PAC Status: Amended
Committee Type: Iowa PAC Statutory Due Date 10/19/2004

County: NA Adjusted Due Date

District: 0 Filed Date 10/23/2004

Committee Code: 6067 Postmark Date

Political Party: Not Available Amendment Date 11/15/2004

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
10/1/2004 Check # Swanson, Tom None $400.00
2857 819 Courtright
Mapleton, IA 51034
10/1/2004 Check # Curphy, Richard None $100.00
2212 David Ct NE
Cedar Rapids, IA 52402
10/1/2004 Check # miscellaneous N/A $1,604.00
contributions
misc., IA 50000
10/1/2004 Check # Holz, Robert None $200.00
5317 1311 Country Club Blvd.
Clive, IA 50325
10/1/2004 Check # Dougherty, Donald None $250.00
3474 3311 Eisenhower Avenue
Ames, IA 50010
10/1/2004 Check # Brown, R. Frank None $1,000.00
3936 1740 Morning Drive P.O. Box 190
Cullman, AL 35056
10/1/2004 Check # Holland, Dana None $100.00
5558 61 Schwartz Dr.
Ottumwa, IA 52501

Total Regular Contributions $16,576.30

Total Fundraiser Contributions $0.00
Grand Total All Contributions $16,576.30

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 6 of 6