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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-746983

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1. Louisiana State Medical Political Action Committee

    NOTE:Commmittee Name is different than previously reported

    6767 Perkins Rd Ste 100
    Baton Rouge, LA 708084263
    Email: mary@lsms.org

2. Date: 10/07/2011

3. FEC Committee ID #: C00001008 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Louisiana State Medical Society
6767 Perkins Road
Suite 100
Baton Rouge, Louisiana 708084263
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

John W. Noble Jr., MD
6767 Perkins Rd Ste 100
Baton Rouge, Louisiana 708084263
Title: Treasurer/Physician
Phone # (225) 763-8500

Designated Agent(s):

Banks or Depositories

Hancock Bank
PO Box 591
Baton Rouge, Louisiana 70821

Morgan Stanley Smith Barney
8550 United Plaza Blvd
Baton Rouge, Louisiana 70809

Signed: John W. Noble Jr., MD
Date Signed: 10/07/2011

(End FEC FORM 1)

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