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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1154139

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1. Iowa Medical Society Political Action Committee

    515 E Locust Street
    Suite 400
    Des Moines, IA 50309
    Email: jhart@iowamedical.org

    NOTE: Email address is different than previously reported

2. Date: 03/28/2017

3. FEC Committee ID #: C00003970 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Committee ID# C00003970
Iowa Medical Society Political Action
515 E Locust Street
Suite 400
Des Moines, Iowa 50309
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Clare M Kelly
515 E Locust Street
Suite 400
Des Moines, IA 503091968

Treasurer:

Gene Lariviere
515 E Locust Street
Suite 400
Des Moines, Iowa 503091968
Title: Treasurer
Phone # (515) 421-4773

Designated Agent(s):

James A Hart
515 E Locust Street
Suite 400
Des Moines, Iowa 50309
Title: Manager Finance
Phone # (515) 421-4773

Banks or Depositories

West Bank
P.O. Box 65020
West Des Moines, Iowa 502650020

Signed: Gene Lariviere
Date Signed: 03/27/2017

(End FEC FORM 1)

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