FEC Form 1 for North Carolina Medical Society Federal Political Education and Action CommitteeForm 1 for North Carolina Medical Society Federal Political Education and Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-428688

1. North Carolina Medical Society Federal Political Education and Action Committee

PO Box 25834
222 N. Person Street
Raleigh, NC 27611

NOTE: Address is different than previously reported

Email: jlewis@ncmedsoc.org

2. Date: 04/24/2006

3. FEC Committee ID #: C00003152 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

North Carolina Medical Society
PO Box 27167
Raleigh, North Carolina 27611
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jean Lewis
NCMS PAC
PO Box 25834
Raleigh, NC 27611
Title: Custodian of Records
Phone # (919) 833-3836

Treasurer:

Edwin Swann
NCMS PAC
PO Box 25834
Raleigh, North Carolina 27611
Title: Treasurer
Phone # (919) 833-3836

Designated Agent(s):

Asst Treasurer Stephen W. Keene
PO Box 25834
222 N. Person Street
Raleigh, North Carolina 27611

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-428688

1. North Carolina Medical Society Federal Political Education and Action Committee

NOTE: Address is different than previously reported

2. Date: 04/24/2006

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Asst Treasurer Stephen W. Keene
Date Signed: 08/03/2009

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-428688

1. North Carolina Medical Society Federal Political Education and Action Committee

NOTE: Address is different than previously reported

2. Date: 04/24/2006

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Asst Treasurer Stephen W. Keene Date Signed: 08/03/2009

(End FEC FORM 1)

Signed: Asst Treasurer Stephen W. Keene
Date Signed: 08/03/2009