Hy Vee Inc Employees PAC6282scanned

8/7/2019 Hy Vee Inc Employees PAC__6282__scanned

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FOR I NSTRUCT I ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGE- 1 t ) D ; ! 1 1 d 6 - 0 ~4 JD - 7

May 1 4 , 2 0 0 6AM F I L I NG A

l 4: - ~ i Yy LPOI N REPORT

( r e p o r t d a t e )CHECK I F AMENDMENT TO REPORT DATED

0Ch e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a n d a t t a c h No t i c e o f D i s s o l u t i o n F or m DR - 3 .( Yo u mu s t c o n t i n u e t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d . )

COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o nHy- Vee , I n c Emp l o y e e s ' P o l i t i c a l Ac t i o n Commi t t e eI MPORTANT : I n d i c a t e b y # t y p e o f c ommi t t e e y o u a r e r e p o r t i n g f o rU( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e St a nd i n g f o r Re t e n t i o n Ca nd i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) Co u nt y C e n t r a l Commi t t e e ( 5 ) Co un t y Ca nd i d at e ( 6 ) C i t y Ca nd i d a t e ( 7 ) S ch oo l B o ar d o r Ot h e rP o l i t i c a l Su bd i v i s i o n Ca nd i d a t e ( 8 ) Co u nt y PAC ( 9 ) C i t y . P AC " ( 1 U0 c h o o l B o ar d o r Ot h e r P o l i t i c a lSu bd i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u e eCANDI DATE COMMI TTEES ONLY :Ca n di d a t e Name

O f f i c e So u g h t

~ o l i t i c a l P a r t y ( i f a p p l i c a b l e )

! , 1 _1 51 1t r i c t ( i f S en a t e o r House )

L at e r e p o r t s a r e s ub j e c t t o p os s i b l e c i v i l a n d c r i m i n a l p en a l t i e s P u r s u a n t t o I o wa Co d e s e c t i o n 68 B. 3 2A( 7 )t h e c a n d i d a t e , f c a n d i d a t e ' s , c o i f e e , a n d t h e c h a i e r s o n , f o r a n y o t h er t y p e o f c ommi t t e e , i s t hei n d i 4 d u a l r e s p s i l e f o r f l i n q n d a cc u r a t e r e p o ~ t s .

REPORT FOR ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .I n d i c a t e b y #

STATEMENT OF CASH ONHANDCASH ON HAND a t t h e b eg i n ni n g o f t he r e p o r t i n g p e r i o d ( T o t a l o f a l l f u nd s h e l d b y t he

c ommi t t e e . T h i s amoun t MUST b e t he s ame a s t h e c a s h o n h an d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d o r mus t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEYTAKEN I N T HI S PERI ODS ch e du l e A : Ca s h Co n t r i b u t i o n s t o t a l ( A t t a c h S c he d u l e A) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . . . .S ch e du l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h S ch e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he d u l e H : T o t a l S al e s o f C amp a i g n P r o p e r t y ( A t t a c h S c he d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a pp l i e s t o Ca n di d a t e s ' Commi t t ees On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $ 4 1 , 5 9 5 . 3 9

SUBTRACT TOTAL MONEYSPENT T HI S PERI ODS ch e du l e B : Ex p e nd i t u r e s t o t a l ( A t t a c h S c he d u l e B ) ( * * a l s o s e e d eb t s a n d l o an s b el o w) . . . . . . . . . . . . . . . 2 , 0 1 5 . 0 0S c he d u l e F : L o a n R e pa yme n t s t o t a l ( A t t a c h S c he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND a t t h e en d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b a l a n c e mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 I DI SCLOSURE( Re v . 1 2 / 2 0 0 5 ) REPORTF o r O f f i c e Use On l yComm #L o g g e d I n~Ml lS c a n n e dCompu t e rAu d i t e d

F i l e w i t h :I o wa E t h i c s a n d C amp a i g nD i s c l o s u r e B oa r d5 1 0 E . 1 2 ' " , St e . 1 ADes Mo i n es , I o wa 5 0 3 1 9F a x : 5 1 5 - 2 8 1 - 3 7 0 1

, 5 / " ,

1

, -/r 62 - 2 9 1 YTEL EPHONE DAT I t S I GNED

L o c a l Commi t t e e s , e n t e r Da t e o f E l e c t i o n

Co u n t y & L o c a l Commi t t e e s , e n t e r Co u n t y i nwh i c h E l e c t i o n i s h e l d

$ 0 . 0 0

2 9 , 5 4 2 . 0 2

1 2 , 0 2 3 . 3 7

3 9 , 5 5 0 . 3 9* * UNP AI D BI L L S ( F r o m Sc h ed u l e D - At t a ch S c he d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N KI N DCONTRI BUTI ONS ( F r o m S c he du l e E - A t t a c h S c he d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * OUTSTANDI NGLOANS ( F r o m S ch ed ul e F - A t t a c h S ch e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSUL TANT BREAKDOWN( Sc h ed u l e G At t a c he d ? ) - YES J NOCANDI DATE COMMI TTEES ONLY:VALUEOF CAMPAI GN PROPERTY ( F r o mS c he d u l e H - A t t a ch S c he d u l e H)STATE COMMI TTEES : Su bmi t a r e c o n c i l e d c a mp a i g n a c c o u n t b a n k s t a t e me n t i n J a n u ar y o f e a c h y e a r .

0 . 0 00 . 0 00 . 0 0


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F o r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e s ' s p e r s o n a l f u n d s )

COMMI TTEE NAME' ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE, I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POLI TI CAL ACTI ON COMMI TTEE) , L I S T T HE PA C I DENTI F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s

SCHEDULEA( Re v 0 2 / 9 6 ) MONETARYRECEI PTS[ ] CHECK THI S BOX I F

AMENDI NG FORM

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h e >c o m m i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y Pag e / Ofm a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e du l e A )f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED

AND PAC CHECK ( i f a p p l i c a b l e )NUMBER

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ga r y Adams1 4 2 6 0 S p r a g u e C i r c l e

CK# n / a Omaha, NE 6 8 1 6 4 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n Amos8 0 1 E H a r v e s t Dr

CK# n / a Mt . P l e a s a n t , l a 5 2 6 4 1 None 5 00 1 / 0 1 / 0 6 t o 0 5 1 1 4 / 0 6 I D# n / a R i c k An d e r s o n1 9 1 1 Ge t hma n n L a n e

CK# n / a Ma r s h a l l t o w n , I A 5 0 1 5 8 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B T A n n a n

1 6 4 2 6 Ma n d er s o n S tCK# n / a Omaha, NE 6 8 1 1 6 None 5 0

0 1 / 0 1 1 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a C h r i s t o p h e r A r n o l d3 4 0 2 Mo n t i c e l l oCK# n / a Wa t e r l o o , I A 5 0 7 0 2 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Du a n e A s c h e2 7 4 1 0 5 0 t h Av eCK# n / a D i x o n , l a 5 2 7 4 5 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Mi c h a e l A u d e r e r1 1 9 4 4 1 1 8 t h Av e .

CK# n / a Ot t umwa , I A 5 2 5 0 1 None 1 60 1 1 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a De n n i s A u s e n h u s

2 8 5 4 NE 9 6 t h S t r e e tCK# n / a A n k e n y , I A 5 0 0 2 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Dave B a i l i e5 8 6 4 Me a d o w V a l l e y C o u r t

CK# n / a We s t De s Mo i n e s I A 5 0 2 6 6 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Br u c e B a i n

5 0 5 Gr o v e Av eCK# n / a C o r n i n g , I A 5 0 8 4 1 None 1 0

SUB- TOTAL 4 7 6TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )


3/23

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a nd i d a t e s ' s p e r s o n a l f u n d s )

COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMASTATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON S ec t i o n 68 B . 3 2 A ( 6 ) , I o wa C o d e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s a n d s t a t e me n t s f o r s o l i c i t i n g c o nt r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s

SCHEDULEA( Re v 0 2 / 9 6 ) MONETARYRECEI PTS

[ ] CHECK THI S BOX I FAMENDI NG FORM

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y Page- Of __2ma r r i a g e) ( See Pa ge 2 o f f o r ms p a c k e t . ) I f su r name o f c o n t r i b u t o r i s t h e sa me as c a n d i d a t e , b u t t h e r e i s no ( f o r Schedu l e A)f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a pp l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a St e p h en B a r a k8 7 9 6 De er C r e s t Dr .

CK# n / a Ceda r R a p i d s , I A 5 2 4 1 1 None 1 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a A l i e n B a r w i c k

5 6 4 0 T wi n Cr Dr .CK# n / a P l e a s a n t H i l l , l a 5 0 3 2 7 None 6 0

0 1 / 0 1 1 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a D a r r e n B a t y7 53 1 Ga r l a ndCK# n / a L i n c o l n , NE 6 8 5 0 5 None 1 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Da v i d B e a c h2 4 2 3 Mc Mu l l i n Dr

CK# n / a O s k a l o o s a , I A 5 2 5 7 7 No n e 3 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Mi k e B e a l s1 2 0 4 S . 3 r d Av e

CK# n / a I n d i a n o l a , l a 5 0 1 2 5 None 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a B e r n a r d B e a r y5 7 1 7 We n t wo r t h DrCK# n / a J o h n s t o n I A 5 0 1 3 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B on n i e B e l l1 3 2 2 7 t h C o u r tCK# n / a We s t De s Mo i n e s , I A 5 0 2 6 5 None 8 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a C h a r l e s B e l l1 2 4 4 3 Do ug l a s Pa r k w a y

CK# n / a U r b a n d a l e , I A 5 0 3 2 3 None 1 0 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Thomas B e n o i t

2 4 1 New Sa l e mCK# n / a C a n t o n , I L 6 1 5 2 0 None 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S t e v e n B i n d s e i l8 0 1 1 N o r t h S p r u c e Av e .CK# n / a K a n s a s C i t y , Mo 6 4 1 1 9 None 5 0

SUB- TOTAL 4 7 5TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) I


4/23



COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE, I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI FI CATI ONNUMBERANDTHEPAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON Se c t i o n 68 B . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s


AMENDI NG FORM

* Di s c l o s u r e l aw r e q u i r e s c a nd i d at e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o ns h i p o f any r e l a t i v e mak i n g a c o nt r i b ut i o n t o t h ec ommi t t e e. Re l a t i o n s h i p mus t be shown t o t he t h i r d d e g r e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v es ) and a f f i n i t y ( r e l a t i v e s by Page `~Ofmar r i a g e ) ( See Page 2o f f o r ms p a c k e t . ) . I f su r name o f c o n t r i b u t o r i s t h e same as c a nd i d a t e , b u t t h e r e i s no ( f o r Sch e d ul e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p pl i c a b l e " i n t h e r e l a t i o ns h i p c o l umn

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED

ANDPAC CHECK ( i f a p p l i c a b l e )NUMBER

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J a s o n B i s h o p1 1 0 6 No r t h Ma i n S t r e e t

CK# n / a Mt . P l e a s t a n t , l a 5 2 6 4 1 Non e 7 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Pa u l B o i s j o l i e87854 Hwy 2 5 1

CK# n / a A u s t i n , MN 55912 Non e 1 2 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e nn i f e r B o o k

1 0 5 0 6 8 t h S t r e e t Ap t # 4CK# n / a We s t Des Mo i n e s , I A 50266 Non e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Thomas B ou b i n9 3 6 0 Ki ngman Dr i v e

CK# n / a We s t Des Mo i n e s , I A 50266 No n e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Da v i d Br a i n a r d3 9 9 6 Hi g h St

CK# n / a We s t Des Mo i n e s , I A 50265 No n e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r k B r a u e r1 4 6 6 NW9 6t h St r e e tCK# n / a C l i v e , I A 50325 None 4 2

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n Br ehm1 2 0 9 S 5 2 n d St #1104

CK# n / a Wes t Des Mo i n e s , I A 50265 None 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n Br i g gs8 S u g a r Cr e e k L a n e

CK# n / a Wauk ee I A 5 0 2 6 3 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J on B r o c e5 1 0 L ak e s i d e Manor Dr i v e

CK# n / a K i r k s v i l l e , MO6 3 5 0 1 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a De n i s e Br o d e r i c k

6 0 0 1 Cr e s t o n Av e #2 4CK# n / a Des Mo i n e s , I A 5 0 3 2 1 N o n e 1 0

SUB- TOTAL 5 17TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e ) I


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COMMI TTEE NAME' ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T T HE PA C I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COLUMN A L I ST OF I D NUMBERS I S AVAI LA BLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m me r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s

SCHEDULEA

( Re v 0 2 / 9 6 )MONETARYRECEI PTS


* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y Page_~_Of _Zjm a r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o ( f o r S c h ed u l e A)f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED

ANDPACCHECK ( i f a p p l i c a b l e )NUMBER

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n B r u mmi t31 0 Pa r k v i e w Dr i v e

CK# n / a Wauk ee, I A 5 0 2 6 3 Non e 25

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ti m Br u z e k1 4 0 9 1 3 t h Av eW

CK# n / a Sp e n c e r , l a 5 1 3 0 1 Non e 250 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ku r r t B u f f i n g t o n

1 2 2 7 Kn o l l c r e s t Dr i v eCK# n / a F o r t Dod g e , I A 5 0 5 0 1 Non e 20

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B i l l y B u l ma n1 0 0 L ak e v i e w Dr i v e

CK# n / a Co l o n a , I L 6 1 2 4 1 Non e 2 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S t e v e B u s c h1 321 L a k e Man or Dr .

CK# n / a Tr e n t o n , MO64683 Non e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ke n n e t h Bu t c h e r71 6 NE 4 4 t h CTCK# n / a A n k e n y I A 5 0 0 2 1 Non e 1 50

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Randy Ca l h o u n6 5 7 0 Pe l i c a n Dr i v e # 2 0 1

CK# n / a Osa ge B e a c h , MO65065 No n e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e f f r e y Ca nf i e l d2 2 0 9 S t o n e b r o o k Dr .

CK# n / a Mu s c a t i n e , l a 5 2 7 6 1 No n e 3 0

0 1 / 0 1 1 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ja mes Ca r n e y70 0 L i n c o l n Rd

CK# n / a S t o r m L a k e , I A 50588 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Wa d e Ch a l s t r o m

43 6 Pr i mr o s e Dr .CK# n / a H u d s o n , l a 50643 None 1 0 0

SUB- TOTAL 7 00TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )


6/23



COMMI TTEE NAME' ( M u s t b e s a m e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TT EE

STATE CANDI DATES NOTE : I F A C ONT RI B UT I ON I S RECEI VED FROMAS T A T E P A C ( P OL I T I CA L A CT I ON COMMI TTEE) , L I S T T HE P AC I DE NT I F I C A TI ONNUMBER ANDTHEPACCHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AV AI L ABL EFROMTHE I OWA E THI C S ANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON Se c t i o n 68 8 . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s

SCHEDULEA( Re v 0 2 / 9 6 ) MONET ARYRECEI PTS


* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2o f f o r m s p a c k e t . ) I f s u r n a m e o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e d u l e A )f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Kwok C h o w1 0 3 0 0 C l a r k

CK# n / a C l i v e , I A 5 0 3 2 5 None 2 50 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi k e C h r i s t e n s e n1 2 15 Ea s t Va n B u r e n

CK# n / a Wa s h i n g t o n I A 5 2 3 5 3 None 1 2 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a De n n i s C l i f t o n

9 0 6 Ma p l eCK# n / a A l b a n y MO 6 4 4 0 2 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a K e n t Co l e1 6 J u l i a n n e D r i v e NWCK# n / a Ced a r R a p i d s , I A 5 2 4 0 5 Non e 7 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a M e r i Co l e s1 5 2 08 Wo o d c r e s t D r i v e

CK# n / a C l i v e , I A 5 0 3 2 5 Non e 4 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ron Co l e s1 5 2 08 Wo o d c r e s t D r i v eCK# n / a C l i v e , I A 5 0 3 2 5 Non e 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a R u t h Comer1 7 4 E v e r g r e en P l a c eCK# n / a We s t De s Mo i n e s , I A 5 0 2 6 5 Non e 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a P a u l a C o r r e y5 6 2 0 S J e r s e y T e s s Dr

CK# n / a S i o u x F a l l s , SD 5 7 1 0 8 Non e 4 10 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J a n e t C r o c k e r6 0 5 SE De l a wa r e

CK# n / a A n k e n y , I A 5 0 0 2 1 None 8 30 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e f f Deah r

1 1 0 6 1 0 t h S t r e e t SWCK# n / a H u m b o l d t , I A 5 0 5 4 8 None 6 0



7/23



COMMI TTEE NAME' ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T T HE PA C I DENTI F I CAT IONNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVAI LA BLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m me r c i a l p ur p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m mi t t e e s



* Di s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e Re l a t i o ns h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o ns an gu i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a ge ) ( Se e Page 2 o f f o r m s p a c k e t . ) I f s u r n a me o f c o nt r i b u t o r i s t h e sa me a s c a n di d a t e , b ut t h e r e i s n of a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a pp l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn

DATE PACI D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a A l l e n De l a n e y2 1 0 9 SE B r i a r Den Co u r t

CK# n / a S i o u x F a l l s , SD 5 7 1 0 8 Non e 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Do u g l a s D e l l65 5 Pa r k Av e

CK# n / a Br o o k i n gs SD 57006 Non e 1 0 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ch r i s t o p h er De s au l n i e r s

1 4 1 8 SE Ri o DrCK# n / a A n k e n y , I A 5 0 0 2 1 Non e 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Gr e g Di l l a v o u1 7 0 1 Mea dow L ar k C i r c l e

CK# n / a L i n c o l n , NE 6 8 5 2 1 None 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a AI Di x2 1 6 5 P o r t Ta l b o t Pl a c e

CK# n / a C o r a l v i l l e , I A 5 2 2 4 1 None 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Wi l l i a m Donahoo20 4 N T ay l o rCK# n / a Mas on C i t y , I A 5 0 4 0 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ch a r l e s Do n ne l l y1 2 5 3 2 Rugby Ct

CK# n / a Du b u q u e , I A 52002 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Do u g l a s Dop1 4 1 Cr e s t v i e w Dr i v e

CK# n / a B u r l i n g t o n , I A 5 2 6 0 1 Non e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B e c k y Do r r9 1 1 0 Ca r p e n t e r C i r c l e

CK# n / a C l i v e , I A 5 0 3 2 5 Non e 350 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Me l i s s a Dr a h e l m

2 6 1 7 K i n g s Po i n t e SWCK# n / a Qu i n c y , I I 6 2 3 0 5 Non e 5 0

SUB- TOTAL 6 65TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )


8/23



COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATECANDI DATES NOTE I F ACONTRI BUTI ON I S RECEI VEDFROMA STATEPAC( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. AL I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 68 B. 3 2 A ( 6 ) , I o w a Co de , p r o h i b i t s t h e u s e of i n f o r ma t i o n c o pi e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o r

f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .


] CHECK THI S BOX I FAMENDI NGFORM

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h e ic ommi t t e e. Re l a t i o n s h i p mus t be sho wn t o t h e t h i r d d e gr e e o f c onsangu i n i t y ( b l o o d r e l a t i v es ) and a f f i n i t y ( r e l a t i v e s by Page Ofma r r i a g e) ( See Page 2 o f f o rms packe t . ) . I f sur name o f c o nt r i b u t o r i s t he same a s c a n d i d a t e , bu t t h e r e i s no ( f o r Schedu l e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p pl i c a b l e " i n t h e r e l a t i o n s hi p co l umn .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE" RECEI V EDAND PAC CHECK ( i f a p p l i c a b l e )

NUMBER0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Do n a l d Dr a k e

8 1 1 Wi l d Rose RdCK# n / a Wi l t o n , I A 5 2 7 7 8 None 1 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n D r i s h

3 2 4 5 Lu n d y La neCK# n / a B e t t e n d o r f I A 5 2 7 2 2 None 9 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a C h r i s t i a n Dy h r k o p p1 1 2 0 3 N . Wa l l a c e

CK# n / a K a n s a s C i t y , MO 6 4 1 5 7 None 2 50 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B r a d l e y Dykes

8 0 7 H i l l c r e s t Gr a n d Av e .CK# n / a Ya n k t o n SD 5 7 0 7 8 None 1 0 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a He l e n E d d y

2 0 9 So 2 7 t h S t r e e tCK# n / a Wes t De s Mo i n e s I A 5 0 2 6 5 None 7 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ran d y E d e k e r2 9 5 5 B e l f r y Dr SWCK# n / a Wa u k e e , I A 5 0 2 6 3 None 1 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a J e f f r e y E s l i c k7 6 0 4 NE 8 6 t h S t r e e t

CK# n / a K a n s a s C i t y , MO 6 4 1 5 7 None 6 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a T e r r y E v a n s

5 3 5 Mi d l o t h i a n B l v d .CK# n / a Wa t e r l o o , I A 5 0 7 0 1 None 1 2 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o e l F l u g

2 0 1 Oa k w o o d C i r c l eCK# n / a Wa v e r l y , l a 5 0 6 7 7 None 6 0 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a T h er e s a F o r b e s1 6 0 9 5 t h Av e . SW

CK# n / a A l t o o n a , I A 5 0 0 0 9 None 1 0 .

SUB- TOTAL 6 7 5 .TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) I


9/23



COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATECANDI DATES NOTE I F ACONTRI BUTI ON I S RECEI VEDFROMA STATEPAC( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. AL I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 68 8 . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e of i n f o r ma t i o n c o pi e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s



* Di s c l o s u r e l aw r e q u i r e s c a nd i d at e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c on t r i b u t i o n t o t hec ommi t t e e . Re l a t i o n sh i p mus t be shown t o t h e t h i r d d e gr e e o f c o ns an gu i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b y PagetOf~ma r r i a g e) ( See Pa ge 2 o f f o r ms p a c k e t . ) I f su r n ame o f c o nt r i b u t o r i s t h e sa me as c a n d i d a t e , b u t t h er e i s n o ( f o r Sc h e d ul e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s hi p c o l umn .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VEDAND PAC CHECK ( i f a p p l i c a b l e )

NUMBER0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Gr e g F r a mp t o n

1 6 6 2 NW1 2 2 n d S t r e e tCK# n / a C l i v e , I A 5 0 3 2 5 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J a mi e F r a n c k8 6 Ph e a s a n t Av e

CK# n / a A t k i n s , I A 5 2 2 0 6 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r y F u h r ma n

1 2 3 0 7 I z a r d S tCK# n / a Omaha, NE 6 8 1 5 4 None 4 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a R i c h a r d F y o c k9 1 2 J a m e s Ri d g e

CK# n / a C r e s t o n , I A 5 0 8 0 1 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Th om a s Ga r d

4 7 1 5 Cl eme n s B l v dCK# n / a Ames , I A 5 0 0 1 4 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a K e v i n G i f f o r d1 1 1 1 Ra p h i n e C i r c l eCK# n / a Rhode s , I A 5 0 2 3 4 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Wi l l i a m G l o s s e r

3 4 0 0 SW3 4 t h S t r e e tCK# n / a Des Mo i n e s , I A 5 0 3 2 0 None 2 5 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ga r y G o o d h a l l2 7 1 0 NW1 6 1 s tCK# n / a C l i v e , I A 5 0 3 2 5 None 2 0 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e r e my Go s c h2 9 2 4 S . O l i v e S t

CK# n / a S i o u x C i t y , I A 5 1 1 0 6 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a T o n y a G r a f f

2 8 2 1 Co u n t r y C l u b D r i v eCK# n / a A t l a n t i c , I A 5 0 0 2 2 None 3 0 .



10/23



COMMI TTEE NAME' ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBERAND THE PAC CHECK NUMBER I N THE DES I GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m me r c i a l p ur p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m mi t t e e s .


] CHECK THI S BOX I FAMENDI NG FORM

* Di s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e Re l a t i o ns hi p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o ns an gu i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a ge ) ( Se e Page 2 o f f o r ms p ac k et . ) I f s u r n a me o f c o n t r i b u t o r i s t h e sa me a s c a nd i d a t e , b u t t h e r e i s n o ( f o r Sc h e d ul e A)f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a pp l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED

AND PACCHECK ( i f a p p l i c a b l e )NUMBER0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a T e r r y G r a y b i l l

5 3 2 B a i l e y C o u r tCK# n / a Ch e r o k e e , I A 5 1 0 1 2 None 3 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n Gr e e n

1 2 2 1 Ru s hr i d g eCK# n / a J e f f e r s o n , I A 5 0 1 2 9 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e f f G r e l l4 3 5 Deb o r a h Av e

CK# n / a F r e m o n t , NE 6 8 0 2 5 None 7 50 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Da v i d Gr o n d

6 0 6 0 N F o r e s t Dr .CK# n / a P a r k v i l l e , MO 6 4 1 5 2 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S h e l l e y H a b e r k o r n3 1 7 SE 8 t hCK# n / a A n k e n y , I A 5 0 0 2 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a K e v i n Ha l b ma i e rP 0 Bo x 2 0 5CK# n / a A l b i a , I A 5 2 5 3 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r k Ha l b ma i e r2 0 8 A u r o r aCK# n / a B o o n e , I A 5 0 0 3 6 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ma r c u s H a l l1 2 1 9 We s t 1 5 t h S t S o u t h

CK# n / a Ne w t o n , I A 5 0 2 0 8 None 1 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a De n n i s H a r t o g h

6 1 0 9 Wi l l o w B r o o k DrCK# n / a A s b u r y , I A 5 2 0 0 2 No n e 7 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ti m Ha u p e r t5 2 6 8 T Av eCK# n / a Ch e r o k e e , I A 5 1 0 1 2 None 5 0 .



11/23



COMMI TTEE NAME' ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T T HE PA C I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVAI LA BLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m m e r c i a l p ur p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mm i t t e e s



* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y P a g e _ Z ! ~ _ _Ofma r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e d u l e A )f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI V ED

AND PACCHECK ( i f a p p l i c a b l e )NUMBER

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a P a t r i c k He n s l e y1 7 9 3 8 B e n t T r e e Ri d ge

CK# n / a C o u n c i l B l u f f s , I A 5 1 5 0 3 None 4 10 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Roger H e p l e r

7 1 4 S t e v e n s S t r e e tCK# n / a I o w a F a l l s , l a 5 0 1 2 6 None 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a C h r i s t o p h e r Hi g g i n b o t h a m2 7 1 0 T a r a H i l l s S t

CK# n / a C o u n c i l B l u f f s , I A 5 1 5 0 3 None 4 90 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a B r e n t H i g h f i l l

9 8 0 5 S k y l i n e C i r c l eCK# n / a J o h n s t o n , l a 5 0 1 3 1 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a C u r t i s H i l l6 0 9 SW1 5 t h T e r r a c e

CK# n / a L e e ' s S ummi t , MO 6 4 0 8 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a D a r i n H i r l1 6 1 6 P a r k h i l l D r i v eCK# n / a N o r w a l k , I A 5 0 2 1 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a C i n d y H o c h1 0 0 9 E a s t He n d e r s o n P l a c e

CK# n / a I n d i a n o l a , I A 5 0 1 2 5 None 7 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a D w i g h t H o c h

5 2 1 7 2 Hwy 1 4CK# n / a C h a r i t o n , I A 5 0 0 4 9 None 4 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a To d H o c k e n s o n5 0 3 C r a i g D r i v eCK# n / a C h e r o k e e , I A 5 1 0 1 2 None 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a L i s a Hoppman8 8 1 Su n n yv i e w Av e .CK# n / a K n o x v i l l e , I L 6 1 4 4 8 None 2 0



12/23



COMMI TTEE NAME' ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T T HE PA C I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LA BLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m m e r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mm i t t e e s

SCHEDULEA( R e v 0 2 / 9 6 ) MONETARYRECEI PTS


* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y Pa g e / Ofma r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e d u l e A )f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI V ED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi c h a e l Ho p pman2 0 0 1 1 2 t h S tCK# n / a E l d o r a , I A 5 0 6 2 7 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a K e v i n H o r ma n n7 0 4 Au g u st a Dr . SE

CK# n / a Ceda r R a p i d s , I A 5 2 4 0 3 None 6 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a F r e d d i e H o u s m a n1 1 0 5 Ma l l o r y L a n e

CK# n / a C h a r i t o n I A 5 0 0 4 9 None 1 0 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Gr e g H u l l

1 4 2 8 9 E l m c r e s t C tCK# n / a C l i v e , I A 5 0 3 2 5 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ma r y Hu n t e r1 3 0 6 1 C l a r k S t .CK# n / a C l i v e , I A 5 0 3 2 5 None 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a K u r t J o h n s o n6 5 0 9 F o x r u n Dr .CK# n / a Ceda r R a p i d s , I A 5 2 4 0 4 No n e 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a B l a n e J o n e s3 2 4 NE Woo d b u r y Dr .

CK# n / a L e e ' s S ummi t , MO 6 4 0 8 6 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a R i c h a r d J u r g e n s

3 0 0 8 J o r d a n Gr o v eCK# n / a We s t De s Mo i n e s I A 5 0 2 6 5 None 5 0 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a T r a c y K a d i n g

2 1 5 5 Co u n t r y C l u b D r i v eCK# n / a Maso n C i t y , I A 5 0 4 0 1 No n e 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a M e r e d i t h K a v a n a g h5 5 0 3 4 1 5 0 t h Av e

CK# n / a L u c a s , I A 5 0 1 5 1 None 2 5



13/23



COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE, I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE. I F A CONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI FI CATI ONNUMBERANDTHEPAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON Se c t i o n 68 B . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s


AMENDI NG FORM

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h e - 7c o mmi t t e e . R e l a t i o n s h i p mus t b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y P a g e 2 - Of Gm a r r i a g e ) ( S e e P a g e 2o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e d u l e A)f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Wi l l i a m K i t t l e r4 0 1 S. J e f f e r s o n

CK# n / a New Ul m, MN 56073 Non e 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a R o s e K l e y we g M i t c h e l l5 7 0 7 Pommel Co u r t

CK# n / a We s t Des Mo i n e s , I A 50266 Non e 1 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J a n e Kn a a c k - Es b e c k

71 5 5 1 s t S t r e e tCK# n / a Des Mo i n e s , I o wa 5 0 3 1 2 Non e 7 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e nn i f e r Ko p r i v a1 632 Ma c k i n Dr

CK# n / a D e w i t t , l a 52742 No n e 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a K a r l Kr u s e8 0 2 1 Ti b u r o n P I

CK# n / a J o h n s t o n , I A 5 0 1 3 1 None 2 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Randy Kr u s e1 4 1 3 6 t h St NECK# n / a Was ec a, MN 5 6 0 9 3 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi c h a e l Kueny7 0 8 7 H i l l c r e s t Co u r t

CK# n / a J o h n s t o n , I A 5 0 1 3 1 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ca r e y L en n i n g6 0 0 1 Cr e s o n Av e #2 4

CK# n / a Des Mo i n e s , I A 5 0 3 2 1 None 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ro b e r t L e wi n2 0 7 Manor Dr

CK# n / a Os c e o l a , I A 50213 No n e 2 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J ames L i n g o

2 5 3 5 He a t h e r v i e w C i r c l eCK# n / a Ma r i o n , I A 52302 No n e 2 0

SUB- TOTAL 5 00TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e ) I


14/23



COMMI TTEE NAME' ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE, I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POLI TI CAL ACTI ON COMMI TTEE) , L I S T T HE PA C I DENTI F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVAI LABLE FROM TH E I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e, p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m me r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s


AMENDI NG FORM

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y Page _ ( _ j Ofm a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) I f s u r n a m e o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e d ul e A )f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi c h a e l L o n g2 0 2 2 Wi l l o w v i e w L n

CK# n / a R o c h e s t e r , MN 5 5 9 0 2 None 6 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n L o n n i n g

9 2 6 0 N . W. 3 6 t h S t r e e tCK# n / a P o l k C i t y , I A 5 0 2 2 6 None 1 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ma t t h e w L u d wi g1 1 1 0 L a mp l i g h t e r L n

CK# n / a L i n c o l n , NE 6 8 5 1 0 None 3 30 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Mi k e Ma g n u s o n4 0 1 SE 8 t h S t r e e t

CK# n / a A n k e n y , I A 5 0 0 2 1 No n e 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a D a v i d Ma r t i n

4 8 6 0 Wa t e r f o r d Dr .CK# n / a We s t De s Mo i n e s , I A 5 0 2 6 5 None 1 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a An t h o n y Mc Can n1 7 9 5 9 t h S tCK# n / a We s t De s Mo i n e s , I A 5 0 2 6 6 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ga r y McCl u r e6 1 5 Gr e e n V a l l e y T e r r .

CK# n / a Ceda r Ra p i d s I A 5 2 4 0 3 None 6 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r k Mc Q u i s t a n3 4 0 1 SW C o u r t Av e

CK# n / a A n k e n y , I A 5 0 0 2 1 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S t e v e Mesc he r3 0 6 1 9 t h S t SE

CK# n / a Ceda r R a p i d s , I A 5 2 4 0 3 None 1 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r k Mi l l s a p

1 8 3 3 0W. 1 6 0 t h T e r r a c eCK# n / a O l a t h e , KS 6 6 0 6 2 None 1 2 5



15/23



COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMASTATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERSI S AVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON S ec t i o n 68 B. 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s



* Di s c l o s u r e l aw r e q u i r e s c a nd i d at e c ommi t t e e s t o d i s c l o s e t he r e l a t i o ns h i p o f any r e l a t i v e mak i n g ac o n t r i b u t i o n t o t h e Ic ommi t t e e . Re l a t i o n sh i p mus t be shown t o t h e t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v es ) an d a f f i n i t y ( r e l a t i v es by Page I Lma r r i a g e) ( See Page 2 o f f o r ms packe t . ) . I f su r name o f c o n t r i b u t o r i s t he same as c a n d i d a t e , b u t t h e r e i s no ( f o r Sc h e d u l e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s hi p c o l umn .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S t e v e Mo k o s a k8 2 1 4W. 1 2 7 t h P l a c e

CK# n / a O v e r l a n d p a r k , KS 6 6 2 1 2 None 3 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B r i a n Moon

1 5 9 No r wo o d D r .CK# n / a C o u n c i l B l u f f s I A 5 1 5 0 3 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J ame s M o o r e , J r .4 6 7 2 3 2 3 5t h T r a i l

CK# n / a C h a r i t o n , I A 5 0 0 4 9 None 2 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a C h r i s t y My e r s

1 4 9 4 9 7 3 r d Av eCK# n / a I n d i a n o l a , I A 5 0 1 2 5 None 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a An d r e w N i e l s e n9 4 0 1 H i c k o r y DrCK# n / a U r b a n d a l e , I A 5 0 3 2 2 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Pa t O h l e r k i n g1 2 0 6 C l a r k S t .CK# n / a C h a r l e s C i t y , I A 5 0 6 1 6 None 2 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Da n Ol s o n2 2 2 0 A s p e n L a n e

CK# n / a N o r t h Ma n k a t o , MN 5 6 0 0 3 None 1 0 00 1 1 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a J o h n Ol s o n

6 1 2 Du r h a m C o u r tCK# n / a L a wr e n c e , KS 6 6 0 4 9 None 4 1

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a C h a r l e s Os b o r n3 5 5 F o r e s t L a n e N .

CK# n / a E l g i n , MN 5 5 9 3 2 No n e 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a C h a r l e s Osma n s k i1 0 0 1 So u t h S t r e e t

CK# n / a We b s t e r C i t y , I A 5 0 5 9 5 None 1 3



16/23



COMMI TTEE NAME' ( M u s t b e s a m e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMASTATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERSI S AVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON: S ec t i o n 68 B. 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .


AMENDI NG FORM

* Di s c l o s u r e l aw r e q u i r e s c an di d at e c ommi t t e e s t o d i s c l o s e t he r e l a t i o ns h i p o f an y r e l a t i v e mak i n g a c on t r i b u t i o n t o t h e Zf.c ommi t t e e . Re l a t i o n s h i p mus t be shown t o t he t h i r d d e g r e e o f c o n s an gu i n i t y ( b l o o d r e l a t i v es ) an d a f f i n i t y ( r e l a t i v e s by Page 'ma r r i a g e ) ( See Page 2o f f o rms p a c k e t . ) . I f su r name o f c o n t r i b u t o r i s t h e same as c a nd i d a t e , b u t t h e r e i s no ( f o r Sc h e du l e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p pl i c a b l e " i n t h e r e l a t i o ns h i p c o l umn

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a C u r t i s Osma n s k i4 1 1 A l b i o n Av e .

CK# n / a F a i r m o n t , MN 5 6 0 3 1 None 4 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi c h a e l O ' T o o l

1 5 5 8 3 0 3 r d Av e .CK# n / a F t Ma d i s o n I A 5 2 6 2 7 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r k P a r k e r1 8 6 3 2 An n e S t r e e t

CK# n / a Omaha, NE 6 8 1 3 5 None 1 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma t t h e w P a r k h u r s t

1 3 0 9 Co t t o n wo o d Dr .CK# n / a Gr e e nw o o d , MO 6 4 0 3 4 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o h n Pe t e r ma n6 2 Sc h wa r t z Dr .

CK# n / a Ot t umwa , I A 5 2 5 0 1 None 1 9

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o n P e t e r s o n7 2 0 5 B r o o k d a l e L a n e NECK# n / a Ceda r R a p i d s , I A 5 2 4 0 2 None 2 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J a m e s Ph i n n e y1 8 5 1 0 2 9 0 t h Roa d

CK# n / a U n i o n v i l l e MO 6 3 5 6 5 None 6 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ro n a l d P i c k e l

1 7 4 0 J u n i p e r L n SWCK# n / a R o c h e s t e r , MN 5 5 9 0 2 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma r k P u l l e n5 4 0 1 SW1 9 t h S t .CK# n / a De s Mo i n e s , I A 5 0 3 1 5 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a J e f f Qu a n d t2 4 1 1 Ri d g e P o i n t C i r c l e

CK# n / a L i n c o l n , NE 6 8 5 1 2 Non e 3 0



17/23


18/23



COMMI TTEE NAME' ( Mu s t b e s a m e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATECANDI DATES NOTE I F ACONTRI BUTI ON I S RECEI VEDFROMA STATEPAC( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. AL I S T OF I D NUMBERS I S AVAI LABLE FROM THEI OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : S ec t i o n 68 B. 3 2 A ( 6 ) , I o w a Co d e , p r o h i b i t s t h e u se o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o r

f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA( R e v 0 2 / 9 6 ) MONETARYRECEI PTS

] CHECK THI S BOX I FAMENDI NGFORM

* Di s c l o s u r e l aw r e q u i r e s c a nd i d at e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s hi p o f an y r e l a t i v e mak i n g a c on t r i b u t i o n t o t he -L rc ommi t t e e Re l a t i o n s h i p mus t be s h own t o t he t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v e s) an d a f f i n i t y ( r e l a t i v e s by Page (2Ofmar r i a g e ) ( See Pa ge 2 o f f o r ms p a c k e t . ) . I f su r name o f c o n t r i b u t o r i s t h e same as c a nd i d a t e , b u t t h e r e i s no ( f o r Sc h e d u l e A)f a mi l i a l r e l a t i o ns h i p , e nt e r " n o t a p pl i c a b l e " i n t h e r e l a t i o ns h i p c o l umn .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TOCANDI DATE* RECEI V ED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a R i c h a r d S h i p l e y3 2 0 1 C r y s t a l D r i v e

CK# n / a B u r l i n g t o n , I A 5 2 6 0 1 None 6 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J ame s S i e me n s

9 7 4 S po o ne r DrCK# n / a Wa t e r t o wn , SD 5 7 2 0 1 None 1 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ke n S i mmo n s2 1 1 Wi n s o r Wa y

CK# n / a S e r g e a n t B l u f f , I A 5 1 0 5 1 None 1 60 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi k e S k o k a n

5 0 1 5 2 n d S t r e e tCK# n / a We s t De s Mo i n e s , I A 5 0 2 6 5 None 1 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a T r a c i S l a y b a u g h4 9 2 0 N . 1 4 2 t h S t .

CK# n / a Omaha, NE 6 8 1 6 4 None 1 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a E r i c S mi t h2 9 4 5 2 2 0 t h S t

CK# n / a Wi n t e r s e t , I A 5 0 2 7 3 Non e 2 50 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a L e wi s S n o o k

1 0 0 4 Wa t e r f r o n t D r i v eCK# n / a A n k e n y , l a 5 0 0 2 3 Non e 2 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a N i c h o l a s S t e i n b a c h2 1 9 3 8 T r a i l r i d g e B l v d

CK# n / a E l k H o r n , NE 6 8 0 2 2 None 1 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B i l l St e p a n e k

3 0 5 5 B r i t t a n y C i r c l eCK# n / a Ced a r R a p i d s , I A 5 2 4 1 1 None 5 0 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ke n S t e p h e n s8 0 8 We s t Ma i nCK# n / a C h e r o k e e , I A 5 1 0 1 2 None 4 0 .

SUB- TOTAL 8 2 6 .TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )


19/23



COMMI TTEE NAME' ( Mu s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATECANDI DATES NOTE I F ACONTRI BUTI ON I S RECEI VED FROM A STATEPAC( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI FI CATI ONNUMBERANDTHEPACCHECK NUMBER I N THE DESI GNATED COLUMN . AL I S T OF I D NUMBERS I S AVAI LABLE FROMTHEI OWA ETHI CSANDCAMPAI GNDI SCLOSUREBOARD

CAUTI ON : Se c t i o n 68 B. 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e of i n f o r ma t i o n c o pi e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s

SCHEDULEA

( Re v 0 2 / 9 6 ) MONETARYRECEI PTS[ ] CHECK THI S BOX I F

AMENDI NG FORM

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e es t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y Page Ofma r r i a ge ) ( Se e Page 2o f f o r ms p ac k et . ) . I f su r name o f c o n t r i b u t o r i s t h e same as c a n di d a t e , b u t t h e r e i s no ( f o r Schedu l e A)f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a pp l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Na t h a n S t e wa r t5 2 0 1 L a k ec r e s t Dr .

CK# n / a S h a w n e e , KS 66218 No n e 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ray S t e wa r t

12864 Cl a r k S t r e e tCK# n / a C l i v e , I A 5 0 3 2 5 No n e 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Mi k e St o e r me r540 Au b u r n H i l l s Dr i v e

CK# n / a C o r a l v i l l e , I A 5 2 2 4 1 No n e 3 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a An d r e w S t r e i t

344 S . 4 8 t h St .CK# n / a We s t Des Mo i n e s , I A 5 0 2 6 5 No n e 2 5

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ma t t h e w S t r e i t209 Wood ch uck L n

CK# n / a Mac omb, I L 6 1 4 5 5 No n e 4 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ki m St r u b324 B r o a d mo o r eCK# n / a So u t h Si o u x C i t y , Ne 68776 No n e 8

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ti mo t h y St u p k a8 0 1 I n v e r n e ss Dr i v e

CK# n / a Si o u x F a l l s , SD 57108 No n e 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J e f f S u c h o m e l

406 We s t S t r e e tCK# n / a S h e n a n d o a h , I A 5 1 6 0 1 No n e 2 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ti m S u l l i v a n1 3 2 2 S t r e e t F - 3 2

CK# n / a Ha r l a n I A 51537 No n e 2 60 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Cy n t h i a S u l z ma n

9 0 6 Me a d o wb r o o k Dr .CK# n / a Ke a r n e y , MO 6 4 0 6 0 No n e 215

SUB- TOTAL 565TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )


20/23



COMMI TTEE NAME' ( Mu s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATECANDI DATES NOTE I F ACONTRI BUTI ON I S RECEI VEDFROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THEPACI DENTI F I CATI ONNUMBERANDTHE PAC CHECK NUMBER I N THEDESI GNATED COLUMN AL I S T OF I D NUMBERSI S AVAI LABLE FROM THE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 68 B. 3 2 A ( 6 ) , I o w a C o d e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA

( Re v 0 2 / 9 6 ) MONETARYRECEI PTS[ ] CHECK THI S BOX I F

AMENDI NG FORM

" Di s c l o s u r e l aw r e q u i r e s c a nd i d at e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o ns h i p o f an y r e l a t i v e mak i n g a c o nt r i b u t i o n t o t h e . - Z (c ommi t t e e Re l a t i o n s h i p mus t b e shown t o t he t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v e s) an d a f f i n i t y ( r e l a t i v e s by Page ~ ~ Ofma r r i a g e) ( See Page 2o f f o rms p a c k e t . ) I f su r name o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , b u t t h e r e i s no ( f o r Sc h e d ul e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p pl i c a b l e " i n t h e r e l a t i o ns h i p c o l umn

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ran d y S u mme r v i l l e4 5 1 6 SWR a i n t r e e Sh o r e Dr .

CK# n / a L e e ' s Summi t MO 6 4 0 8 2 None 5 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S u z i Su n d h o l m

2 6 0 4 E . 3 5 t h S t . C t .CK# n / a D a v e n p o r t , I A 5 2 8 0 7 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ro n a l d T a y l o r5 5 5 We s t wo o d s Dr .

CK# n / a Wa u k e e , I A 5 0 2 6 3 None 1 0 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ro b e r t T e e s e l i n k

2 0 6 Wood A c r e sCK# n / a A l g o n a , I A 5 0 5 1 1 None 3 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a S c o t t T h omp s o n8 1 2 S ou t h 1 s t Av e

CK# n / a I o w a C i t y , I A 5 2 2 4 5 No n e 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a R o b e r t T r a d e r7 0 9 S ou t h O u t l o o k D r .CK# n / a S i o u x F a l l s , SD 5 7 1 0 6 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a To m T wo h i l l1 50 8 Lo n e Oak C i r c l e

CK# n / a F a i r f i i e l d , I A 5 2 5 5 6 None 3 00 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a K e i t h Va n Gen t

7 2 0 2 2 n d Av eCK# n / a S h e l d o n , I A 5 1 2 0 1 None 5 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ra n d y V a n d e r l e e s t1 3 1 2 B e l a i r eCK# n / a P o l k C i t y , I A 5 0 2 2 6 No n e 2 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a P h i l l i p Wa l k e r1 5 8 0 8 W1 2 6 t h T e r r a c e

CK# n / a O l a t h e KS 6 6 0 6 2 None 5 0



21/23



COMMI TT EE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE, I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TT EES T A T E C A NDI DA T ES N OT E : I F A C ONT RI B UT I ON I S RECEI VEDFROMAS TATE PAC ( P OL I T I C A L A CT I ON COMMI TTEE) , L I S T T HE PA C I DE NT I F I C AT I ONNUMBER ANDT HE P ACCHECKNUMBER I N THEDESI GNATED COLUMN AL I S T OF I D NUMBERSI S AVAI LABLEFROMTHE I OWA E THI C SANDCAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: S ec t i o n 68 B . 3 2 A ( 6 ) , I o wa C o d e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p os e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA( Re v 0 2 / 9 6 ) MONET ARYRECEI PTS

[ ] CHECK THI S BOX I FAMENDI NG F ORM

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y PageZ Ofma r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o ( f o r Sc h e d u l e A )f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) T O CANDI DATE* RECEI VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Ke n Wa l l e r8 0 2 4 T i b u r o n P l a c e

CK# n / a J o h n s t o n , I A 5 0 1 3 1 None 6 20 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Th om a s Wa t s o n

8 1 0 0 H e a t h e r B o w C r tCK# n / a J o h n s t o n , I A 5 0 1 3 1 None 1 0 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a J ame s Wa t t e r s1 8 5 0 Ma c k e n z i e Dr .

CK# n / a Ced a r R a p i d s , I A 5 2 4 1 1 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Mi c h a e l We b b

3 0 9 NW1 2 t h DrCK# n / a L e o n , I A 5 0 1 4 4 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a A l a n We i s e r t1 4 3 0 Ed g e w a t e r D r .

CK# n / a A l b e r t L e a , MN 5 6 0 0 7 No n e 6 0

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J o n Wen de l8 3 1 9 Ch am b e r yCK# n / a J o h n s t o n , I A 5 0 1 3 1 None 5 0 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S h a r mWe n n d t3 6 3 3 E . 5 9 t h C o u r t

CK# n / a D a v e n p o r t , I A 5 2 8 0 7 None 3 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a De n n i s We r n l i

PO Bo x 3 3 9CK# n / a Woo d wa r d , I A 5 0 2 7 6 None 2 5 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a G r e g o r y We r y6 4 9 3 C u t l e r S t

CK# n / a Wa t e r l o o , l a 5 0 7 0 3 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a J i m Wi c h ma n

1 3 0 4 So u t h T a y b e r r y Av eCK# n / a S i o u x F a l l s , SD 5 7 1 0 6 None 5 0 .

SUB- TOTAL 5 2 7 .TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )


22/23


( I n c l u d i n g c a nd i d a t e s ' s p er s o na l f u n d s )

COMMI TTEE NAME' ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )HY- VEE , I NC EMPLOYEES' POLI T I CAL ACTI ON COMMI TTEESTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( P OL I T I C A L ACTI ON COMMI TT EE) , L I S T THE PAC I DENT I F I CA T IONNUMBER ANDTHEPAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERSI S AVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON Se c t i o n 68 B. 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r m at i o n c op i e d f r o m r e p or t s a n d s t a t e me n t s f o r s o l i c i t i n g c o nt r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h er t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

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AMENDI NG FORM

* Di s c l o s u r e l aw r e q ui r e s c a nd i d at e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o ns h i p o f an y r e l a t i v e mak i n g a c on t r i b u t i o n t o t he 2c ommi t t e e . Re l a t i o n sh i p mus t be shown t o t h e t h i r d d e gr e e o f c o ns an gu i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s by Page L! Ofma r r i a g e) ( See Pa ge 2 o f f o rms p a c k e t . ) I f su r n ame o f c o nt r i b u t o r i s t h e sa me as c a n di d a t e , b u t t h e r e i s n o ( f o r Sc h e d u l e A)f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a p pl i c a b l e " i n t h e r e l a t i o n s hi p c o l umn .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED


0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Mo n t e Wi e s e2 9 2 9 Wo o d l a n d H i l l Dr .

CK# n / a D a l l a s C e n t e r , I A 5 0 0 6 3 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a Do n Wi l k e n s

6 6 4 0 Mo n t i c e l l o C o u r tCK# n / a J o h n s t o n , I A 5 0 1 3 1 None 7 5 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a S c o t t Wi l k i n s o n6 3 3 5 S u t t o n Dr .

CK# n / a U r b a n d a l e , I A 5 0 3 2 2 None 2 5 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a L i s a Wo l t ma n

9 5 8 5 7 0 t h S tCK# n / a Ch e r o k e e , I A 5 1 0 1 2 None 1 5 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a Ran d y Wo o d3 5 4 A s c en s i o n P o i n t

CK# n / a H o l t s S u mmi t , MO 6 5 0 4 3 None 5 0 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a F r a n k Wo o dwa r d7 1 2 4 J o y c e S t .CK# n / a Omaha, NE 6 8 1 3 8 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D# n / a B r e n t Y a g e r

4 1 5 S 4 6 6t h Av eCK# n / a V e r m i l l i o n , Sd 5 7 0 6 9 None 5 0 .

0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a S c o t t Y ou n g b e r g3 5 1 0 Ri mr o c k Dr NE

CK# n / a Ced a r R a p i d s , I A 5 2 4 0 2 None 5 0 .0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a

CK# n / a None0 1 / 0 1 / 0 6 t o 0 5 / 1 4 / 0 6 I D # n / a

CK# n / a None

SUB- TOTAL 3 6 5 .TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 2 , 0 2 3 1


23/23

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Di s b u r s e me n t f o rUP r i ma r yLGe n e r a lOt h e r ( s p e c i f y )E. F u l l Name, Ma i l i n g A d d r e s s a n d ZI P Code P u r p o s e o f Di s b u r s e me n t Da t e ( m o n t h , Amou n t o f E a c hd a y , y e a r ) Di s bu r s emen t T h i s P e r i o d

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Di s b u r s e me n t f o r P r i ma r y G e n e r a l) O t h e r ( s p e c i f y )

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Hy Vee Inc Employees PAC6282scanned

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Hy Vee Inc Employees PAC__6282__scanned

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Transcript of Hy Vee Inc Employees PAC__6282__scanned

Hy Vee Inc Employees PAC6282scanned

Transcript of Hy Vee Inc Employees PAC6282scanned