FEC Form 1 for AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEEForm 1 for AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1301928

1. AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE

25 Massachusetts Ave, NW
Suite 600
Washington, DC 200017400
Email: ampaconline@ama-assn.org

2. Date: 12/01/2018

3. FEC Committee ID #: C00000422 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

DELAWARE MEDICAL PAC
900 PRIDES CROSSING
Newark, Delaware 197136100
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003921
DISTRICT OF COLUMBIA MEDICAL PAC
1250 23RD STREET, NW
#270
Washington, DC 200371216
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00000638
INDIANA STATE MEDICAL ASSOCIATION PAC
322 CANAL WALK
Indianapolis, Indiana 462023278
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00004911
ALABAMA MEDICAL PAC
PO BOX 22
Montgomery, Alabama 361010022
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001776
New Mexico Medical Society PAC
316 Osuna Road, NE
Suite 501
Albuquerque, New Mexico 871075956
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003152
NORTH CAROLINA MEDICAL SOCIETY FEDERAL
PO BOX 25834
222 N PERSON STREET
Raleigh, North Carolina 276115834
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00548438
WISCONSIN MEDICAL SOCIETY PAC
330 EAST LAKESIDE STREET
Madison, Wisconsin 537152074
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00005488
ILLINOIS STATE MEDICAL SOCIETY POLITIC
20 NORTH MICHIGAN AVENUE
SUITE 700
Chicago, Illinois 606024822
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003327
OHIO STATE MEDICAL ASSOCIATION PAC
5115 PARKCENTER AVENUE
#200
Dublin, Ohio 430177553
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00039123
NEW JERSEY MEDICAL POLITICAL ACTION CO
2 PRINCESS ROAD
Lawrenceville, New Jersey 086482320
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003061
NORTH DAKOTA MEDICAL ASSOCIATION POLIT
1622 E INTERSTATE AVE
Bismarck, North Dakota 585030512
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003194
CALIFORNIA MEDICAL ASSOCIATION PAC-FED
555 CAPITOL MALL
#400
Sacramento, California 958144503
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003475
SOUTH CAROLINA MEDICAL PAC
132 WESTPARK BLVD
Columbia, South Carolina 292103856
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00004929
PENNSYLVANIA MEDICAL SOCIETY POLITICAL
PO BOX 8820
Harrisburg, Pennsylvania 171058820
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003970
IOWA MEDICAL SOCIETY PAC
515 EAST LOCUST
#400
Des Moines, Iowa 503091968
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00009449
IDAHO MEDICAL POLITICAL ACTION COMMITT
PO BOX 2668
305 WEST JEFFERSON
Boise, Idaho 837012668
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00005132
SOUTH DAKOTA STATE MEDICAL ASSOCIATION
2600 WEST 49TH STREET
#200
Sioux Falls, South Dakota 571056569
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00035766
OREGON MEDICAL PAC
11740 SW 68TH PARKWAY
#100
Portland, Oregon 972239038
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00002501
MARYLAND MEDICAL PAC
1211 CATHEDRAL STREET
Baltimore, Maryland 212015516
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001354
INDEPENDENT MEDICINES PAC
701 BRADFORD AVENUE
Nashville, Tennessee 372042209
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00028415
WYOMING MEDICAL PAC
PO DRAWER 4009
Cheyenne, Wyoming 820034009
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003178
MINNESOTA MEDICAL PAC
1300 GODWARD STREET, NE
Suite 2400
Minneapolis, Minnesota 554131776
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001461
ALASKA STATE MEDICAL ASSOCIATION POLIT
4107 LAUREL STREET
Anchorage, Alaska 995085334
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00002147
NEBRASKA MEDICAL ASSOCIATION PAC
233 S 13TH STREET
Lincoln, Nebraska 685082017
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001834
Medical Society of Virginia PAC
2924 Emerywood Parkway
Suite 300
Richmond, Virginia 232943746
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001214
TEXAS MEDICAL ASSOCIATION PAC
401 W 15TH STREET
Austin, Texas 787011624
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00016444
KENTUCKY MEDICAL ASSOCIATION PAC
9300 SHELBYVILLE ROAD
#800
Louisville, Kentucky 402225166
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00004804
MISSISSIPPI MEDICAL PAC
408 WEST PARKWAY PLACE
Ridgeland, Mississippi 391576010
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00004192
COLORADO MEDICAL PAC
7351 E. Lowry Boulevard
#110
Denver, Colorado 802306083
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00002907
ARKANSAS MEDICAL SOCIETY PAC
PO BOX 55088
Little Rock, Arkansas 722155088
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001685
GEORGIA MEDICAL PAC
1849 THE EXCHANGE
#200
Atlanta, Georgia 303392027
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00004499
ARIZONA MEDICAL ASSOCIATION, INC POLIC
810 W. BETHANY HOME ROAD
Phoenix, Arizona 850131654
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00003210
UTAH MEDICAL PAC
310 EAST 4500 SOUTH
#500
Salt Lake City, Utah 841074250
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001347
HAWAII MEDICAL PAC
1360 S BERETANIA STREET
#200
Honolulu, Hawaii 968141520
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001420
MISSOURI MEDICAL PAC
PO BOX 1402
Jefferson City, Missouri 651021402
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00000547
KANSAS MEDICAL SOCIETY PAC
623 SW 10TH AVENUE
Topeka, Kansas 666121615
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00280701
MEDICAL SOC OF THE ST OF NY PAC
99 WASHINGTON AVENUE
#408
Albany, New York 122102811
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001552
Rhode Island Medical PAC
405 Promenade Street
#A
Providence, Rhode Island 029084834
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00007484
FLORIDA MEDICAL ASSOCIATION PAC
1430 EAST PIEDMONT DRIVE
Tallahassee, Florida 323087942
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001180
MICHIGAN DOCTORS PAC-MICHIGAN STATE ME
PO BOX 769
East Lansing, Michigan 488260769
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00039248
NEVADA MEDICAL PAC
5355 KIETZKE LANE
#100
Reno, Nevada 895114002
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001669
MAINE MEDICAL PAC
PO BOX 190
Manchester, Maine 043510190
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00206417
NEW HAMPSHIRE MEDICAL SOCIETY PHYSICIA
7 NORTH STATE STREET
Concord, New Hampshire 033014039
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00527663
MONTPAC-MONTANA MEDICAL ASSOCIATION
2021 11TH AVENUE
Helena, Montana 596014882
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001818
WASHINGTON STATE MEDICAL PAC
2001 6TH AVENUE
#2700
Seattle, Washington 981212547
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00030007
OKLAHOMA STATE MEDICAL ASSOCIATION PAC
313 NORTHEAST 5OTH
OKLAHOMA CITY, Oklahoma 73105
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00001008
LOUISIANA STATE MEDICAL SOCIETY PAC
6767 PERKINS ROAD
#100
Baton Rouge, Louisiana 708084257
Affiliated Relationship Code: Affiliated Committee

CONNECTICUT STATE MEDICAL PAC
127 WASHINGTON AVENUE
EAST BUILDING, 3RD FLOOR
New Haven, Connecticut 065191616
Affiliated Relationship Code: Affiliated Committee

MASSACHUSETTS MEDICAL SOCIETY
860 WINTER STREET
Waltham, Massachusetts 024511449
Affiliated Relationship Code: Affiliated Committee

VERMONT MEDICAL SOCIETY
PO BOX 1457
134 MAIN STREET
Montpelier, Vermont 056011457
Affiliated Relationship Code: Affiliated Committee

WEST VIRGINIA MEDICAL PAC
PO BOX 4106
Charleston, West Virginia 253644106
Affiliated Relationship Code: Affiliated Committee

AMERICAN MEDICAL ASSOCIATION
330 N Wabash Ave
Ste 39300
Chicago, Illinois 60611
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Kevin Walker
25 Massachusetts Ave NW
Ste 600
Washington, DC 200017400
Title: Custodian of Records
Phone # (202) 789-7467

Treasurer:

Mr. Kevin Walker
25 Massachusetts Ave NW
Ste 600
Washington, DC 200017400
Title: Treasurer
Phone # (202) 789-7467

Designated Agent(s):

Stephen Alan Imbeau, MD
800 E Cheves St Ste 420
Allergy Asthma and Sinus Ctr
Florence, South Carolina 295062649
Title: Secretary
Phone # (843) 679-9335

Mr. John Robert Jordan
25 Massachusetts Avenue, NW
Suite 600
Washington, DC 200017400
Title: Assistant Treasurer
Phone # (202) 789-7457

Mrs. Nicole Lonetto
25 Massachusetts Avenue, NW
Suite 600
Washington, DC 200017400
Title: Assistant Treasurer
Phone # (202) 789-7433

Banks or Depositories

PNC Bank
PO Box 1912
Washington, DC 20074

PNC Advisors
800 17th Street, NW
Washington, DC 20006

Signed: Mr. Kevin Walker
Date Signed: 12/20/2018
Official Committee URL: www.ampaconline.org

(End FEC FORM 1)

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