FEC Form 1 for Iowa Medical Society Political Action CommitteeForm 1 for Iowa Medical Society Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-495603

1. Iowa Medical Society Political Action Committee

NOTE:Commmittee Name is different than previously reported

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

2. Date: 09/30/2010

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

Affiliated Committees/Organizations

Iowa Medical Society
1001 Grand Avenue
West Des Moines, Iowa 502653502
Affiliated Relationship Code: Connected Organization

Committee ID# C00000422
AMERICAN MEDICAL ASSOCIATION POLITICAL
25 MASSACHUSETTS AVENUE NW
SUITE 600
WASHINGTON, DC 20001
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Mr. Michael Abrams
1001 Grand Avenue
West Des Moines, IA 502653502
Title: EVP
Phone # (515) 223-1401

Treasurer:

Gene Lariviere
1001 Grand Avenue
West Des Moines, Iowa 502653502
Title: Treasurer
Phone # (515) 223-1401

Designated Agent(s):

Mr. R Edward Whitver
1001 Grand Avenue
West Des Moines, Iowa 50265
Title: Sr. VP-Admin
Phone # (515) 223-1401

Banks or Depositories

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

Signed: Gene Lariviere
Date Signed: 09/30/2010
Official Committee URL: www.iowamedical.org

(End FEC FORM 1)

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