FEC Form 1 for AMERICAN MEDICAL RESPONSE INC POLITICAL ACTION COMMITTEEForm 1 for AMERICAN MEDICAL RESPONSE INC POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-164747

1. AMERICAN MEDICAL RESPONSE INC POLITICAL ACTION COMMITTEE

6200 S SYRACUSE WAY STE 200
GREENWOOD VILLAGE, CO 80111
Fax: 3034951295

2. Date: 02/11/2005

3. FEC Committee ID #: C00389585 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00398271
None
1717 MAIN STREET SUITE 5200
DALLAS, Texas 75201
Relationship: Affiliated Committee

AMERICAN MEDICAL RESPONSE INC
6200 S. Syracuse Way Suite 200
Greenwood Village, Colorado 80111
Organization Type: Corporation

Custodian of Records:

Miss Cynthia Jane Stalvey
6200 S. Syracuse Way Suite 200
Greenwood Village, CO 80111
Phone # (303) 495-1419

Treasurer:

Mark Rector
6200 S. Syracuse Way STE 200
Greenwood, Colorado 80111
Phone # (303) 495-1213

Designated Agent(s):

Mark Rector
6200 S. Syracuse Way STE 200
Greenwood, Colorado 80111
Title: Treasurer
Phone # (303) 495-1413

Miss Cynthia Jane Stalvey
6200 S. Syracuse Way Suite 200
Greenwood Village, Colorado 80111
Title: Assistant Treasurer
Phone # (303) 495-1419

Banks or Depositories

Wells Fargo
P.O. Box 5247
Denver, Colorado 80274

Signed: Mark Rector
Date Signed: 02/11/2005
Official Committee FAX: 3034951295

(End FEC FORM 1)

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