FEC Form 1 for Indiana State Medical Association Political Action CommitteeForm 1 for Indiana State Medical Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1135694

1. Indiana State Medical Association Political Action Committee

322 Canal Walk, Canal Level
Indianapolis, IN 46202
Email: rbennett@ismanet.org

NOTE: Email address is different than previously reported

2. Date: 12/20/2016

3. FEC Committee ID #: C00000638 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Indiana State Medical Association
322 Canal Walk, Canal Level
Indianapolis, Indiana 46202
Affiliated Relationship Code: Connected Organization

Committee ID# C00000422
AMERICAN MEDICAL ASSOCIATION POLITICAL
25 MASSACHUSETTS AVENUE NW
SUITE 600
WASHINGTON, DC 20001
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Treasurer:

Vidya Kora, M.D.
322 Canal Walk, Canal Level
Indianapolis, Indiana 46202
Title: Treasurer
Phone # (317) 261-2060

Designated Agent(s):

Banks or Depositories

Huntington National Bank
P.O. Box 6054
Indianapolis, Indiana 46206

Signed: Vidya Kora, M.D.
Date Signed: 12/20/2016

(End FEC FORM 1)

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