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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-431432

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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: 09/03/2009

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

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: assistant
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
Title: Asst Treasurer
Phone # (919) 833-3836

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

Banks or Depositories

Wachovia Bank
PO Box 563966
Raleigh, North Carolina 28262

Signed: Asst Treasurer Stephen W. Keene
Date Signed: 09/03/2009
Official Committee URL: www.ncmedsoc.org/pac

NOTE: URL is different than previously reported

(End FEC FORM 1)

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