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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-265449

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1. Iowa Medical Political Action Committee

    1001 Grand Avenue
    West Des Moines, IA 502653502
    Fax: 5152230590
    Email: dpotter@iowamedical.org

2. Date: 12/12/2006

3. FEC Committee ID #: C00003970 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

, ____

Designated Agent(s):

Banks or Depositories

Signed: Dr. Kenneth Schultheis
Date Signed: 12/12/2006
Official Committee URL: www.iowamedical.org
Official Committee FAX: 5152230590

(End FEC FORM 1)

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