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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-410106

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1. Utah Medical Political Action Committee

    310 East 4500 South
    Suite 500
    Salt Lake City,, UT 841074250

    NOTE: Address is different than previously reported

    Email: claudia@utahmed.org

    NOTE: Email address is different than previously reported

2. Date: 03/27/2009

3. FEC Committee ID #: C00003210 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00000422
American Medical Political Action Committee
1101 Vermont Ave., NW
Chicago,, Illinois 20005
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Ms Claudia S Peterson
310 East 4500 So
SLC, UT 84107
Title: Acctng Mng
Phone # (801) 747-3500

Treasurer:

Michelle McOmber
310 East 4500 So.
SLC, Utah 84107
Phone # (801) 747-3500

Designated Agent(s):

Banks or Depositories

Signed: Michelle McOmber
Date Signed: 03/27/2009

(End FEC FORM 1)

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