FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DR-2 DISCLOSURE
DISCLOSURE SUMMARY PAGE (Rev . 02/96) REPORT

For Office Use Only

COMMITTEE NAME (Must be same as on Statement of Organization) Comm . #
Hy-yee, Inc . Employees' Political Action Committege Indexed

0 Audited

(
IMPORTANT : Indicate type of committee you are reporting for:
Computer
1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate
( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee
( 8 )Support SIB of Candidi

GNATURE OF S ER (or person filing this report) TELEPPIONE DATE SIGNED

Penalties Due For Late Filed Reports Range from $10 to $400

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:

I AM FILING A REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .

Indicate one

MCHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

County & Local Committees, enter County in

p Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
which Election is held
(You must continue to file reports until a Notice of Dissolution is filed.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (This is the total
of all monies held by the committee. This amount MUST be the
same as the cash on hand at the end of the last reporting period,
or must be zero if this is first report filed .) . ... .. . .... .. .. .. .. .. . . .. .... . . . .... . . . .. . . . .. .. .. ..... .. .. .. .. .. .. .. .. .. .. .$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) .. . . . ..... .. .. .. ... .. ........... .. .. .. .. .... . . ...
Schedule C : Fund-raising Events total (Attach Schedule C) . . .. .. ... .. .. .. . .. .. ..... ...... .. .. .. .. .... . . ...
Schedule F : Loans Received total (Attach Schedule F) .. .. .. .. .. ...... .. .. .. ..... ..... ..... .. . .... .. ..... . ...
Schedule H : Total Sales of Campaign Property (Attach Schedule H) ... .. ..... ...... .. .. .. .. .... . ....
(Schedule H applies to Cand idates' Committees Only)

SUB-TOTAL ....$
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) .... .. .. .. .. .. ...... .. .. .. ........ .. ..... ... .... .. ..... ....
Schedule F: Loan Repayments total (Attach Schedule F) .. .. .. .... .. .. .... ........ ....... .. ....., ..... . ....

CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) .. .. ...... ............. .... .. .. ..... .. .. .. ........... .. .. .. .. ... . .. .. .... ..... . . . .. ..... . . .... . .. ..... ....$

UNPAID BILLS (From Schedule D - Attach Schedule D) . .. .. .. .. .. ... . . .. .. . . .. . . . ... ...... . ..... .. ... .. .. ..... ....... ....$ ,
IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .. .. .... ................ ..... .. .. .... ...... .. .... $
OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . ... ......... ............... ..... .. .. .... .... .. .. ....$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by anyperson other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01101/05 to 06/30/05 ID# n/a Gary Adams
14260 Sprague Circle
CK# n/a Omaha, NE 68164 None 41 .34

01/01/05 to 06/30/05 ID# n/a John Amos

801 E. Harvest Dr .
CK# n/a Mt. Pleasant, la 52641 None 60 .00

01/01/05 to 06/30/05 ID# n/a Rick Anderson

1005 Prairie View PI
CK# n/a Rockford, la 50468 None 33 .34

01101/05 to 06/30/05 ID# n/a B T Annan

16426 Manderson St
CK# n/a Omaha, NE 68116 None 30 .00

01/01/05 to 06/30/05 ID# n/a Christopher Arnold

3402 Monticello
CK# n/a Waterloo, IA 50702 None 50 .00

01/01/05 to 06/30/05 ID# n/a Duane Asche

27410 50th Ave
CK# n/a Dixon, la 52745 None 86 .68

01/01/05 to 06/30/05 ID# n/a Michael Auderer

11944 118th Ave .
CK# n/a Ottumwa, IA 52501 None 20.00

01/01/05 to 06/30105 ID# n/a Dennis Ausenhus

2854 NE 96th Street
CK# n/a Ankeny, IA 50021 None 50 .00

01/01/05 to 06/30/05 ID# n/a Dave Bailie

5864 Meadow Valley Court
CK# nla West Des Moines IA 50266 None 60 .00

01/01/05 to 06/30/05 ID# n/a Bruce Bain

505 Grove Ave.
CK# n/a Corning, IA 50841 None 10 .00

SUB-TOTAL 441 .36

TOTAL (if last page of this schedule) I

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page_/_Of~
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 688.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Stephen Barak
8796 Deer Crest Dr .
CK# n/a Cedar Rapids, IA 52411 None 9 .98

01/01/05 to 06/30/05 ID# n/a Matthew Barkalow

4753 70th Place
CK# n/a Urbandale, la 50322 None 8 .34

01/01/05 to 06/30/05 ID# n/a Allen Barwick

5640 Twin Cr . Dr .
CK# nla Pleasant Hill, la 50327 None 60.00

01/01/05 to 06/30/05 ID# n/a Michael Basch

2303 Vernon Ave
CK# n/a Norfolk, NE 68701 None 5 .00

01/01/05 to 06/30/05 ID# n/a Darren Baty

7531 Garland
CK# n/a Lincoln, NE 68505 None 10 .00

01/01/05 to 06/30/05 ID# n/a David Beach

2423 McMullin Dr.
CK# n/a Oskaloosa, IA 52577 None 30 .00

01/01/05 to 06/30/05 ID# n/a Mike Beals

1204 S . 3rd Ave.
CK# n/a Indianola, la 50125 None 30.00

01/01/05 to 06/30/05 ID# n/a Bernard Beary

5717 Wentworth Dr
CK# n/a Johnston IA 50131 None 60 .00

01/01/05 to 06/30/05 ID# n/a Mary Beiker

6201 E .P . True Parkway
CK# n/a West Des Moines, IA 50266 None 40 .00

01/01/05 to 06/30/05 ID# n/a Bonnie Bell

4733 Woodlawn #3
CK# n/a West Des Moines, IA 50266 None 80 .00

Bonnie Bell SUB-TOTAL 333 .32

4733 Woodlawn #3 TOTAL (if last page of this schedule) I

es, bb
* Disclosure law requires candidate committees to di! ;--)y
;-Of-,L
Page-
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 of forms packet.). If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Charles Bell
615 Park St . #1312
CK# n/a Des Moines, Iowa 50309 None 100 .00

01/01/05 to 06/30/05 ID# n/a Thomas Benoit

765 Terrae Lane
CK# n/a Winona, MN 55987 None 40 .00

01/01/05 to 06/30/05 ID# n/a Steven Bindseil

8011 North Spruce Ave .
CK# n/a Kansas City, Mo 64119 None 55 .00

01/01/05 to 06/30/05 ID# n/a Jason Bishop

1106 North Main Street
CK# n/a Mt . Pleastant, la 52641 None 60 .00

01/01/05 to 06/30/05 ID# n/a Paul Boisjolie

87854 Hwy 251
CK# n/a Austin, MN 55912 None 120 .00

01/01/05 to 06/30/05 ID# n/a Jennifer Book

3011 Bluff Ridge Dr .
CK# n/a Quincy, IL 62301 None 90 .00

01/01/05 to 06/30/05 ID# n/a Thomas Boubin

9360 Kingman Drive
CK# n/a West Des Moiones, IA 50266 None 60 .00

01/01/05 to 06/30/05 ID# n/a David Brainard

1007 W . 3rd Ave #100
CK# n/a Indianola, la 50125 None 60.00

01/01/05 to 06/30/05 ID# n/a Mark Brauer

1466 NW 96th Street
CK# n/a Clive, IA 50325 None 51 .00

01/01/05 to 06/30/05 ID# n/a John Briggs

8 Sugar Creek Lane
CK# n/a Waukee IA 50263 None 60 .00

I
Bonnie Bell SUB-TOTAL 696 .00

4733 Woodlawn #3 TOTAL (if last page of this schedule)

West Ues Moines, IA 5ULbb
* Disclosure law requires candidate committees to di,
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page - Of~
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Jon Broce
510 Lakeside Manor Drive
CK# n/a Kirksville, MO 63501 None 50 .00

01/01/05 to 06/30/05 ID# n/a Denise Broderick

6001 Creston Ave #24
CK# n/a Des Moines, IA 50321 None 10 .00

01/01/05 to 06/30/05 ID# n/a John Brummit

310 Parkview Drive
CK# n/a Waukee, IA 50263 None 10.00

01/01/05 to 06/30/05 ID# n/a Tim Bruzek

1409 13th Ave W
CK# n/a Spences, la 51301 None 30 .00

01/01/05 to 06/30/05 ID# n/a Kurrt Buffington

1227 Knollcrest Drive
CK# n/a Fort Dodge, IA 50501 None 13 .34

01/01/05 to 06/30/05 ID# n/a Billy Bulman

100 Lakeview Drive
CK# n/a Calona, IL 51241 None 200 .00

01/01/05 to 06/30/05 ID# n/a Steve Busch

1321 Lake Manor Dr .
CK# n/a Trenton, MO 64683 None 53 .34

01/01/05 to 06/30/05 ID# n/a Kenneth Butcher

1018 Campus Ridge Ct.
CK# n/a Ankeny IA 50021 None 150.00

01/01/05 to 06/30/05 ID# n/a Randy Calhoun

700 W . 46th St .
CK# n/a Kansas City, MO 64112 None 60 .00

01/01/05 to 06/30/05 ID# n/a Jeffrey Canfield

2209 Stonebrook Dr .
CK# n/a Muscatine, la 52761 None 30 .00

Bonnie Bell SUB-TOTAL 606 .68

4733 Woodlawn #3 TOTAL (if last page of this schedule)

West Lies Moines, IA 50266
Disclosure law requires candidate committees to di ,
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) ( ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01105 to 06/30/05 ID# n/a James Carney
700 Lincoln Rd
CK# n/a Storm Lake, IA 50588 None 60 .00

01/01/05 to 06/30/05 ID# n/a Wade Chalstrom

436 Primrose Dr .
CK# n/a Hudson, la 50643 None 100 .00

01/01/05 to 06/30/05 ID# n/a Gregory Chapman

711 Peaceful Way
CK# n/a Maryville, MO 64468 None 33 .34

01/01/05 to 06/30/05 ID# n/a Kwok Chow

10300 Clark
CK# n/a Clive, IA 50325 None 30 .00

01/01/05 to 06/30/05 ID# n/a Mike Christensen

1215 East Van Buren
CK# n/a Washington IA 52353 None 120 .00

01/01/05 to 06/30/05 ID# n/a Renee Cirksena

9312 Happy Hollow
CK# n/a Norwalk, IA 50211 None 20 .00

01/01/05 to 06/30/05 ID# n/a Dennis Clifton

906 Maple
CK# n/a Albany MO 64402 None 60.00

01/01105 to 06/30/05 ID# n/a Kent Cole

16 Julianne Drive NW
CK# n/a Cedar Rapids, IA 52405 None 70.00

01/01/05 to 06/30/05 ID# n/a Meri Coles

15208 Woodcrest Drive
CK# n/a Clive, IA 50325 None 40 .00

01/01/05 to 06/30/05 ID# n/a Ron Coles

15208 Woodcrest Drive
CK# nla Clive, IA 50325 None 30 .00

Bonnie Bell SUB-TOTAL 563 .34

4733 Woodlawn #3
West Des Moines, IA 5U166
TOTAL (if last page of this schedule) I
3
Disclosure law requires candidate committees to di .,
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page ~ Of
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Ruth Comer
174 Evergreen Place
CK# n/a West Des Moines, IA 50265 None 30 .00

01/01/05 to 06/30/05 ID# n/a Casey Connor

725 Mosher
CK# n/a Owatonna, MN 55060 None 25 .00

01/01/05 to 06/30/05 ID# n/a Paula Correy

5620 S Jersey Tess Dr
CK# n/a Sioux Falls, SD 57108 None 49 .98

01/01/05 to 06/30/05 ID# n/a Janet Crocker

605 SE Delaware
CK# n/a Ankeny, IA 50021 None 100 .02

01/01/05 to 06/30/05 ID# n/a Jeff Deahr

1106 10th Street SW
CK# n/a Humboldt, IA 50548 None 60 .00

01/01/05 to 06/30/05 ID# n/a Allen Delaney

2109 Briar Den Court
CK# n/a Sioux Falls, SD 57108 None 100 .00

01/01/05 to 06/30/05 ID# n/a Douglas Dell

655 Park Ave
CK# n/a Brookings SD 57006 None 100 .00

01/01/05 to 06/30/05 ID# n/a Christopher Desaulniers

1418 SE Rio Dr
CK# n/a Ankeny, IA 50021 None 60.00

01/01/05 to 06/30/05 ID# n/a Greg Dillavou

1701 Meadow Lark Circle
CK# n/a Lincoln, NE 68521 None 60.00

01/01/05 to 06/30/05 ID# n/a Al Dix

2618 Catskill Ct .
CK# n/a Iowa City, IA 52245 None 60 .00

SUB-TOTAL 645 .00

TOTAL (if last page of this schedule) I

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page of
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by anyperson other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a William Donahoo
204 N Taylor
CK# n/a Mason City, IA 50401 None 83 .34

01/01/05 to 06/30/05 ID# n/a Charles Donnelly

12532 Rugby Ct
CK# n/a Dubuque, IA 52002 None 100.00

01/01/05 to 06/30/05 ID# n/a Douglas Dop

141 Crestview Drive
CK# n/a Burlington, IA 52601 None 60 .00

01/01/05 to 06/30/05 ID# n/a Becky Dorr

9110 Carpenter Circle
CK# n/a Clive, IA 50325 None 40 .00

01/01/05 to 06/30/05 ID# n/a Melissa Drahelm

2617 Kings Pointe SW
CK# n/a Quincy, II 62305 None 50 .00

01/01/05 to 06/30/05 ID# n/a Donald Drake

811 Wild Rose Rd
CK# n/a Wilton, IA 52778 None 10 .00

01/01/05 to 06/30/05 ID# n/a John Drish

3245 Lundy Lane
CK# n/a Bettendorf IA 52722 None 90 .00

01/01/05 to 06/30/05 ID# n/a Christian Dyhrkopp

11203 N. Wallace
CK# n/a Kansas City, MO 64157 None 30.00

01/01/05 to 06/30/05 ID# n/a Bradley Dykes

807 Hillcrest Grand Ave.
CK# n/a Yankton SD 57078 None 120.00

01/01/05 to 06/30/05 ID# n/a Helen Eddy

209 So 27th Street
CK# n/a West Des Moines IA 50265 None 90 .00

SUB-TOTAL 673.34

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
Page--20f-,23
marriage) (See Page 2 of forms packet.). If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by anyperson other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Randy Edeker
8103 W. 129th Terrace
CK# n/a Overlandpark, KS 66213 None 150.00

01/01/05 to 06/30/05 ID# n/a Jeffrey Eslick

7604 NE 86th Street
CK# n/a Kansas City, MO 64157 None 60 .00

01/01/05 to 06/30/05 ID# n/a Terry Evans

535 Midlothian Blvd .
CK# n/a Waterloo, IA 50701 None 120.00

01/01/05 to 06/30/05 ID# n/a Steve Fassler

210 Ridgeview
CK# n/a Cherokee, IA 51012 None 40 .00

01/01/05 to 06/30/05 ID# n/a Joel Flug

201 Oakwood Circle
CK# n/a Waverly, la 50677 None 60 .00

01/01/05 to 06/30/05 ID# n/a Theresa Forbes

1609 5th Ave. SW
CK# n/a Altoona, IA 50009 None 10 .00

01/01/05 to 06/30/05 ID# n/a Greg Frampton

1662 NW 122nd Street
CK# n/a Clive, IA 50325 None 60 .00

01/01/05 to 06/30/05 ID# n/a Jamie Franck

6 Greenbrier Ct
CK# n/a Keokuk, IA 52632 None 60.00

01/01/05 to 06/30/05 ID# n/a Mary Fuhrman

320 N 18th St .
CK# n/a Estherville, la 51334 None 60.00

01/01/05 to 06/30/05 ID# n/a Richard Fyock

912 James Ridge
CK# n/a Creston, IA 50801 None 60 .00

SUB-TOTAL 680.00

TOTAL (if last page of this schedule)

` Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page of
marriage) (See Page 2 of forms packet.). If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Thomas Gard
4715 Clemens Blvd
CK# n/a Ames, IA 50014 None 30 .00

01/01/05 to 06/30/05 ID# n/a Kevin Gifford

8703 Hwy 6E
CK# n/a Kellogg, IA 50135 None 50 .00

01/01/05 to 06/30/05 ID# n/a Dennis Glick

2289 Deri Place
CK# n/a Perry IA 50220 None 40 .00

01/01/05 to 06/30/05 ID# n/a William Glosser

3400 SW 34th Street
CK# n/a Des Moines, IA 50320 None 50 .00

01/01/05 to 06/30/05 ID# n/a Gary Goodhall

2710 NW 161st
CK# n/a Clive, IA 50325 None 20 .00

01/01/05 to 06/30/05 ID# n/a Jeremy Gosch

2001 12th St
CK# n/a Eldora, la 50624 None 60 .00

01/01/05 to 06/30/05 ID# n/a Tonya Graff

2821 Country Club Drive
CK# n/a Atlantic, IA 50022 None 30.00

01/01/05 to 06/30/05 ID# n/a Terry Graybill

532 Bailey Court
CK# n/a Cherokee, IA 51012 None 30.00

01/01/05 to 06/30/05 ID# n/a John Green

1221 Rushridge
CK# n/a Jefferson, IA 50129 None 83.34

01/01/05 to 06/30/05 ID# n/a Jeff Grell

1640 Ohio Street
CK# n/a Fremont, NE 68025 None 85 .00

SUB-TOTAL 478 .34

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page Of
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a David Grond
209 Woodchuck Lane
CK# n/a Macomb, IL 61455 None 30 .00

01/01/05 to 06/30/05 ID# n/a Shelley Haberkorn

317 SE 8th
CK# n/a Ankeny, IA 50021 None 50 .00

01/01/05 to 06/30/05 ID# n/a Kevin Halbmaier

6764 180th St.
CK# n/a Albia, IA 52531 None 50 .00

01/01/05 to 06/30/05 ID# n/a Mark Halbmaier

208 Aurora
CK# n/a Boone, IA 50036 None 50 .00

01/01/05 to 06/30/05 ID# n/a Marcus Hall

1219 West 15th St. South
CK# n/a Newton, IA 50208 None 150.00

01/01/05 to 06/30/05 ID# n/a Dennis Hartogh

701 Clover Lane
CK# n/a Storm Lake, IA 50588 None 60 .00

01/01/05 to 06/30/05 ID# n/a Tim Haupert

5268 T Ave
CK# n/a Cherokee, IA 51012 None 50.00

01/01/05 to 06/30/05 ID# n/a Patrick Hensley

109 Applewood Court
CK# n/a Council Bluffs, IA 51503 None 50.04

01/01/05 to 06/30/05 ID# n/a Roger Hepler

714 Stevens Street
CK# n/a Iowa Falls, la 50126 None 60 .00

01/01/05 to 06/30/05 ID# n/a Brent Highfill

9805 Skyline Circle
CK# n/a Johnston, la 50131 None 120.00

SUB-TOTAL 670.04

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page_Of
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . ALIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutorypolitical committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Curtis Hill
609 SW 15th Terrace
CK# n/a Lee's Summit, MO 64081 None 60 .00

01/01/05 to 06/30/05 ID# n/a Darin Hirl

1616 Parkhill Drive
CK# n/a Norwalk, IA 50211 None 50 .00

01/01/05to06/30/05 ID# n/a Thomas Hobt

405 Breconshire Ln
CK# n/a Coralville, la 52241 None 100.00

01/01/05 to 06/30/05 ID# n/a Cindy Hoch

1009 East Henderson Place
CK# n/a Indianola, IA 50125 None 80 .00

01/01/05 to 06/30/05 ID# n/a Dwight Hoch

RR1 Box 40
CK# n/a Chariton, IA 50049 None 40 .00

01/01/05 to 06/30/05 ID# n/a Tod Hockenson

503 Craig Drive
CK# n/a Cherokee, IA 51012 None 30 .00

01/01/05 to 06/30/05 ID# n/a Randy Hockom

1725 Marcella Heights
CK# n/a Carroll, IA 51401 None 50 .00

01/01/05 to 06/30/05 ID# n/a Lisa Hoppman

826 Sunnyview Ave .
CK# n/a Knoxville, IA 61448 None 20.00

01/01/05 to 06/30/05 ID# n/a Kevin Hormann

704 Augusta Dr. SE
CK# n/a Cedar Rapids, IA 52403 None 60 .00

01/01/05 to 06/30/05 ID# n/a Freddie Housman

49124 177th Trail
CK# n/a Chariton IA 50049 None 120.00

I
SUB-TOTAL 610.00

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page__h_Of
marriage) (See Page 2 of forms packet.) . If sumame of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements forsoliciting contributions or
for any commercial purpose by anyperson other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (ifapplicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a John Hubler
2895 Silver Oak Trail
CK# n/a Marion, IA 52302 None 100.00

01/01/05 to 06/30/05 ID# n/a Greg Hull

14289 Elmcrest Ct
CK# n/a Clive, IA 50325 None 33 .34

01/01/05 to 06/30/05 ID# n/a Mary Hunter

9708 Valdez Drive
CK# n/a Urbandale, IA 50322 None 30 .00

01/01/05 to 06/30/05 ID# n/a Dennis Husman

414 Sac
CK# n/a Cherokee, IA 51012 None 20.00

01/01/05 to 06/30/05 ID# n/a Kurt Johnson

6509 Foxrun Dr .
CK# n/a Cedar Rapids, IA 52404 None 30 .00

01/01/05 to 06/30/05 ID# n/a Blane Jones

324 NE Woodbury Dr.
CK# n/a Lee's Summit, MO 64086 None 60 .00

01/01/05 to 06/30/05 ID# n/a Richard Jurgens

3008 Jordan Grove
CK# n/a West Des Moines IA 50265 None 500.00

01/01/05 to 06/30/05 ID# n/a Tracy Kading

2155 Country Club Drive
CK# n/a Mason City, IA 50401 None 60 .00

01/01/05 to 06/30/05 ID# n/a Meredith Kavanagh

55034 150th Ave
CK# n/a Lucas, IA 50151 None 30.00

01/01/05 to 06/30/05 ID# n/a William Kittler

401 S. Jefferson
CK# n/a New Ulm, MN 56073 None 33.34

SUB-TOTAL 896.68

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page Of
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Rose Kleyweg Mitchell
5707 Pommel Court
CK# n/a West Des Moines, IA 50266 None 150.00

01/01/05 to 06/30/05 ID# n/a Gary Kline

18267 North Line Dr .
CK# n/a Council Bluffs, IA 51503 None 60 .00

01/01/05 to 06/30/05 ID# n/a Jane Knaack-Esbeck

715 51st Street
CK# n/a Des Moines, Iowa 50312 None 90 .00

01/01/05 to 06/30/05 ID# n/a Jennifer Kopriva

1632 Mackin Dr
CK# n/a Dewitt, la 52742 None 60 .00

01/01/05 to 06/30/05 ID# n/a Daryl Kruse

2913 SW Caulder
CK# n/a Des Moines IA 50321 None 30 .00

01/01/05 to 06/30/05 ID# n/a Randy Kruse

1413 6th St NE
CK# n/a Waseca, MN 56093 None 50 .00

01/01/05 to 06/30/05 ID# n/a Michael Kueny

7087 Hillcrest Court
CK# n/a Johnston, IA 50131 None 30 .00

01/01/05 to 06/30/05 ID# n/a Carey Lenning

6001 Creson Ave #24
CK# n/a Des Moines, IA 50321 None 30 .00

01/01/05 to 06/30/05 ID# n/a Robert Lewin

207 Manor Dr
CK# n/a Osceola, IA 50213 None 20.00

01/01/05 to 06/30/05 ID# n/a James Lingo

2535 Heatherview Circle
CK# n/a Marion, IA 52302 None 20.00

SUB-TOTAL 540.00

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page 3 Of &)3_
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section68B.32A(6), Iowa Code, prohibits the use of information copied from reports andstatements forsoliciting contributions or
for any commercial purpose by anyperson other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE" RECEIVED
AND PAC CHECK (ifapplicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Michael Long
3534 Birchwood Lane SW
CK# n/a Rochester, MN 55902 None 60 .00

01101/05 to 06/30/05 ID# n/a John Lonning

9260 N.W . 36th Street
CK# n/a Polk City, IA 50226 None 150.00

01/01/05 to 06130/05 ID# n/a Matthew Ludwig

1110 Lamplighter Ln
CK# n/a Lincoln, NE 68510 None 50 .00

01/01/05 to 06/30/05 ID# n/a Mike Magnuson

401 SE 8th Street
CK# n/a Ankeny, IA 50021 None 50.00

01/01/05 to 06/30/05 ID# n/a David Martin

4860 Waterford Dr .
CK# n/a West Des Moines, IA 50265 None 10 .00

01/01/05 to 06/30/05 ID# n/a Anthony McCann

179 59th St
CK# n/a West Des Moines, IA 50266 None 120.00

01/01/05 to 06/30/05 ID# n/a Gary McClure

615 Green Valley Terr.
CK# n/a Cedar Rapids IA 52403 None 60 .00

01/01/05 to 06/30/05 ID# n/a Mark Mc Quistan

3401 SW Court Ave.
CK# n/a Ankeny, IA 50021 None 50 .00

01/01/05 to 06/30/05 ID# n/a Steve Mescher

306 19th St SE
CK# n/a Cedar Rapids, IA 52403 None 20 .00

01/01/05 to 06/30/05 ID# n/a Jim Meyer

13050 Walnut Ridge Circle
CK# n/a Clive, Iowa 50325 None 30.00

SUB-TOTAL 600.00

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the L 23
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page / Of
marriage) (See Page 2 of forms packet.) . If sumame of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ) CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person otherthan statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Mark Millsap
18330 W. 160th Terrace
CK# n/a Olathe, KS 66062 None 150.00

01/01/05 to 06/30/05 ID# n/a Steve Mokosak

8214 W. 127th Place
CK# n/a Overlandpark, KS 66213 None 30 .00

01/01/05 to 06/30/05 ID# n/a Brian Moon

159 Norwood
CK# n/a Council Bluffs IA 51503 None 160.00

01/01/05 to 06/30/05 ID# n/a James Moore, Jr .

46723 235th Trail
CK# n/a Chariton, IA 50049 None 20 .00

01/01/05 to 06/30/05 ID# n/a Christy Myers

1493 73rd Ave.
CK# n/a Indianola, IA 50125 None 30 .00

01/01/05 to 06/30/05 ID# n/a Andrew Nielsen

9401 Kickory Dr
CK# n/a Urbandale, la 50322 None 120.00

01/01/05 to 06/30/05 ID# n/a Pat Ohlerking

1206 Clark St .
CK# n/a Charles City, IA 50616 None 24 .00

01/01/05 to 06/30/05 ID# n/a Dan Olson

2220Aspen Lane
CK# n/a North Mankato, MN 56003 None 100.00

01/01/05 to 06/30/05 ID# n/a John Olson

612 Durham Court
CK# n/a Lawrence, KS 66049 None 43.34

01/01/05 to 06/30/05 ID# n/a Charles Osborn

355 Forest Lane N.
CK# n/a Elgin, MN 55932 None 50 .00

SUB-TOTAL 727.34

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page if
marriage) (See Page 2 of forms packet.). If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 688.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Charles Osmanski
1001 South Street
CK# n/a Webster City, IA 50595 None 20 .00

01/01/05 to 06/30/05 ID# n/a Curtis Osmanski

411 Albion Ave .
CK# n/a Fairmont, MN 56031 None 40 .00

01/01/05 to 06/30/05 ID# n/a Michael O'Tool

1558 303rd Ave .
CK# n/a Ft Madison IA 52627 None 30 .00

01/01/05 to 06/30/05 ID# n/a Mark Parker

2513 Apache Dr .
CK# n/a Sioux City, IA 51104 None 10 .00

01/01/05 to 06/30/05 ID# n/a Matthew Parkhurst

1309 Cottonwood Dr .
CK# n/a Greenwood, MO 64034 None 30 .00

01/01/05 to 06/30/05 ID# n/a Dave Perkins

307 Kellogg
CK# n/a Dallas Center, IA 50063 None 10 .00

01/01/05 to 06/30/05 ID# n/a Jon Peterson

7205 Brookdale Lane NE
CK# n/a Cedar Rapids, IA 52402 None 20 .00

01/01/05 to 06/30/05 ID# n/a James Phinney

RR #3 Box #28
CK# n/a Unionville MO 63565 None 60 .00

01/01/05 to 06/30/05 ID# n/a Ronald Pickel

1740 Juniper Ln SW
CK# n/a Rochester, MN 55902 None 33 .34

01/01/05 to 06/30/05 ID# n/a Mark Pullen

5401 SW 19th St .
CK# n/a Des MOines, IA 50315 None 30.00

SUB-TOTAL 283.34

TOTAL (if last page of this schedule) I

/6
* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page Of
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section68B.32A(6), Iowa Code, prohibits the use of information copied from reports andstatements forsoliciting contributions or
for any commercial purpose by anyperson otherthan statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (ifapplicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Jeff Quandt
3425 Casa Grande Lane
CK# n/a Lincoln, NE 68516 None 30 .00

01/01/05 to 06/30/05 ID# n/a David Rasmussen

150 Circle Dr .
CK# n/a Galesburg, IL 61401 None 30 .00

01/01/05 to 06/30/05 ID# n/a Kevin Reeve

703 N 11th
CK# n/a Chariton, IA 50049 None 20 .00

01/01/05 to 06/30/05 ID# n/a Rodney Rogotzke

2504 Fairview
CK# n/a Chillicothe, MO 64601 None 30 .00

01/01/05 to 06/30/05 ID# n/a Bryan Romig

1108 S. 3rd St.
CK# n/a Grimes, IA 50111 None 40 .00

01/01/05 to 06/30/05 ID# n/a Brian Rose

405 N Quincy Ave
CK# n/a Ottumwa, la 52501 None 80 .00

01/01/05 to 06/30/05 ID# n/a Doug Rouse

Box 234A
CK# n/a Lamoni, IA 50140 None 16 .66

01/01/05 to 06/30/05 ID# n/a Scott Schatter

5932 S. 81 st St .
CK# n/a Lincoln, NE 68516 None 50 .00

01/01/05 to 06/30/05 ID# n/a Dan Schmedding

216 Chancery Lane
CK# n/a Mankato, MN 56001 None 100.00

01/01/05 to 06/30/05 ID# n/a James Scott

4501 99th Street
CK# n/a Urbandale, IA 50322 None 150.00

SUB-TOTAL 546.66

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Of Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page (
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutorypolitical committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Tom Settle
684 62nd Street
CK# n/a West Des Moines, IA 50266 None 50 .00

01/01/05 to 06/30/05 ID# n/a Alan Shank

1422 Forest Lane
CK# n/a Faribault, MN 55021 None 60 .00

01/01/05 to 06/30/05 ID# n/a Kevin Sherlock

241 New Salem Dr .
CK# n/a Canton, IL 61520 None 120.00

01/01/05 to 06/30/05 ID# n/a Richard Shipley

3201 Crystal Drive
CK# n/a Burlington, IA 52601 None 60 .00

01/01/05 to 06/30/05 ID# n/a James Siemens

1311 13th St. NE
CK# n/a Watertown, SD 57201 None 10 .00

01/01/05 to 06/30/05 ID# n/a Ken Simmons

211 Winsor Way
CK# n/a Sergeant Bluff, IA 51051 None 20 .00

01/01/05 to 06/30/05 ID# n/a Mike Skokan

501 52nd Street
CK# n/a West Des Moines, IA 50265 None 135.00

01/01/05 to 06/30/05 ID# n/a Traci Slaybaugh

4920 N. 142th St .
CK# n/a Omaha, NE 68164 None 150.00

01/01/05 to 06/30/05 ID# n/a Eric Smith

3901 NW Windbrooke, Ct .
CK# n/a Ankeny, IA 50021 None 30 .00

01/01/05 to 06/30/05 ID# n/a Lewis Snook

1004 Waterfront Drive
CK# n/a Ankeny, la 50021 None 200.00

SUB-TOTAL 835.00

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page of 2- 3
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688.32A(6), Iowa Code, prohibits the use of information copied from reports and statements forsoliciting contributions or
for any commercial purpose by anyperson other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (ifapplicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Nicholas Steinbach
21938 Trailridge Blvd
CK# n/a Elk Hoen, NE 68022 None 100.00

01/01/05 to 06/30/05 ID# n/a Bill Stepank

3055 Brittany Circle
CK# n/a Cedar Rapids, IA 52411 None 60 .00

01/01/05 to 06/30/05 ID# n/a Ken Stephens

808 West Main
CK# n/a Cherokee, IA 51012 None 40 .00

01/01/05 to 06/30/05 ID# n/a Ray Stewart

12864 Clark Street
CK# n/a Clive, IA 50325 None 110.00

01/01/05 to 06/30/05 ID# n/a Mike Stoermer

540 Auburn Hills Drive
CK# n/a Coralville, IA 52241 None 30 .00

01/01/05 to 06/30/05 ID# nla Andrew Streit

344 S. 48th St .
CK# n/a West Des Moines, IA 50265 None 30 .00

01/01/05 to 06/30/05 ID# n/a Matthew Streit

1512 Eckerson Dr.
CK# n/a Worthington, MN 56187 None 35 .00

01/01/05 to 06/30/05 ID# n/a Kim Strub

324 Broadmoore
CK# n/a South Sioux City, Ne 68776 None 10 .02

01/01/05 to 06/30/05 ID# n/a Timothy Stupka

801 Inverness Drive
CK# n/a Sioux Falls, SD 57108 None 50 .00

01/01/05 to 06/30/05 ID# n/a Jeff Suchomel

406 West Street
CK# n/a Shenandoah, IA 51601 None 20.00

SUB-TOTAL 485.02

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page I Of
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS ANDCAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting conhibulions or
for any commercial purpose by any person other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Tim Sullivan
1311 Baldwin
CK# n/a Harlan IA 51537 None 41 .66

01/01/05 to 06/30/05 ID# n/a Cynthia Sulzman

15319 W 79th Terrace
CK# nla Lenexa, KS 66219 None 96 .00

01/01/05 to 06/30/05 ID# n/a Randy Summerville

4219 SW Homestead Ct
CK# n/a Lee's Summit MO 64082 None 50.00

01/01/05 to 06/30/05 ID# n/a Suzi Sundholm

2604 E. 35th St . Ct .
CK# n/a Davenport, IA 52807 None 50 .00

01/01/05 to 06/30/05 ID# n/a Ronald Taylor

555 Westwoods Dr.
CK# n/a Waukee, IA 50263 None 120 .00

01/01/05 to 06/30/05 ID# n/a Robert Teeselink

206 Wood Acres
CK# n/a Algona, IA 50511 None 30 .00

01/01/05 to 06/30/05 ID# n/a Michael Tetmeyer

3529 SW 29th St
CK# n/a Des Moines IA 50321 None 30 .00

01/01/05 to 06/30/05 ID# n/a Scott Thompson

812 South 1 st Ave
CK# n/a Iowa City, IA 52245 None 60.00

01/01/05 to 06/30/05 ID# n/a Robert Trader

709 South Outlook Dr.
CK# n/a Sioux Falls, SD 57106 None 86.68

01/01/05 to 06/30/05 ID# n/a Tom Twohill

1508 Lone Oak Circle
CK# n/a Fairfield, IA 52556 None 60.00

SUB-TOTAL 624.34

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page ,;Z& Of,2 33
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
 For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section68B.32A(6), Iowa Code, prohibits the use of information copied from reports andstatements forsoliciting contributions or
for any commercial purpose by anyperson other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (ifapplicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Keith Van Gent
720 22nd Ave
CK# n/a Sheldon, IA 51201 None 33 .34

01/01/05 to 06/30/05 ID# n/a Randy Vanderleest

1312 Belaire
CK# n/a Polk City, IA 50226 None 20 .00

01/01/05 to 06/30/05 ID# n/a Vern Vogel

626 N 8th St
CK# n/a Chartion, IA 50049 None 10 .00

01/01/05 to 06/30/05 ID# n/a Ronald Waldbillig

5925 E P True Parkway #4
CK# n/a West Des Moines, IA 50266 None 30 .00

01/01/05 to 06/30/05 ID# n/a Phillip Walker

15808 W 126th Terrace
CK# n/a Olathe KS 66062 None 60 .00

01/01/05 to 06/30/05 ID# n/a Ken Waller

8024 Tiburon Place
CK# n/a Johnston, IA 50131 None 62.50

01/01105 to 06/30/05 ID# n/a Thomas Watson

920 Forest Edge Dr.
CK# n/a Coralville, IA 52241 None 100.00

01/01/05 to 06/30/05 ID# n/a James Watters

1815 Mackenzie Dr .
CK# n/a Cedar Rapids, IA 52411 None 50 .00

01/01/05 to 06/30/05 ID# n/a Michael Webb

309 NW 12th Dr
CK# n/a Leon, IA 50144 None 50 .00

01/01/05 to 06/30/05 ID# n/a Daniel Weiler

406 N . Railroad
CK# n/a Albany, MO 64402 None 60 .00

SUB-TOTAL 475.84

TOTAL (if last page of this schedule)

' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .
For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) [ ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC. EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section68B.32A(6), Iowa Code, prohibits the use of information copied from reports andstatements forsoliciting contributions or
for any commercial purpose by any person otherthan statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE' RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Alan Weisert
1430 Edgewater Dr .
CK# n/a Albert Lea, MN 56007 None 60 .00

01/01/05 to 06/30/05 ID# n/a Jon Wendel

8319 Chambery
CK# n/a Johnston, IA 50131 None 60 .00

01/01/05 to 06/30/05 ID# n/a Sharm Wenndt

3633 E. 59th Court
CK# n/a Davenport, IA 52807 None 30 .00

01/01/05 to 06/30/05 ID# n/a Dennis Wernli

603 Cedar Ave
CK# n/a Woodward, IA 50276 None 30 .00

01/01/05 to 06/30/05 ID# n/a Gregory Wery

6493 Cutler St
CK# n/a Waterloo, la 50703 None 60 .00

01/01/05 to 06/30/05 ID# n/a Jim Wichman

1304 South Tayberry Ave
CK# n/a Sioux Falls, SD 57106 None 43 .34

01/01/05 to 06/30/05 ID# n/a Monte Wiese

6313 NW 95th
CK# n/a Johnston, la 50131 None 60 .00

01/01/05 to 06/30/05 ID# n/a Don Wilkens

6640 Monticello Court
CK# n/a Johnston, IA 50131 None 90 .00

01/01/05 to 06/30/05 ID# n/a Scott Wilkinson

6335 Sutton Dr .
CK# n/a Urbandale, IA 50322 None 30 .00

01/01/05 to 06/30/05 ID# n/a Lisa Woltman

5806 J Ave.
CK# n/a Cherokee, IA 51012 None 15 .00

SUB-TOTAL 478.34

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page J_ ', of
marriage) (See Page 2 of forms packet .). If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column.
For Instructions, See Back of Form
SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidates's personal funds) (Rev. 02/96) RECEIPTS

COMMITTEE NAME' (Must be same as on Statement of Organization) ( ] CHECK THIS BOX IF

AMENDING FORM
HY-VEE, INC . EMPLOYEES' POLITICAL ACTION COMMITTEE
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC(POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by anyperson other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

(if applicable) TO CANDIDATE* RECEIVED
AND PAC CHECK (if applicable)
NUMBER
01/01/05 to 06/30/05 ID# n/a Randy Wood
354 Ascension Point
CK# n/a Holts Summit, MO 65043 None 80 .00

01/01/05 to 06/30/05 ID# n/a Frank Woodward

7124 Joyce St
CK# n/a Omaha, Ne 68138 None 60 .00

01/01/05 to 06/30/05 ID# n/a Brent Yager

3000 Norman Drive
CK# n/a Sioux City, IA 51104 None 70 .00

01/01/05 to 06/30/05 ID# n/a Scott Youngberg

3510 Rimrock Drive NE
CK# n/a Cedar Rapids, IA 52402 None - 100.00

01/01/05 to 06/30/05 ID# n/a

CK# n/a None

01/01/05 to 06/30/05 ID# n/a

CK# n/a None

01 /01 /05 to 06/30/05 I D# n/a

CK# n/a None

01/01/05 to 06/30/05 ID# n/a

CK# n/a None

01 /01/05 to 06/30/05 ID# n/a

CK# n/a None

01/01/05 to 06/30/05 ID# n/a

CK# n/a None

SUB-TOTAL 310.00

TOTAL (if last page of this schedule) 13,199 .981

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Page 3 of_,,~
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no (for Schedule A)
familial relationship, enter "not applicable" in the relationship column .