FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-769854
1. Iowa Medical Society Political Action Committee
NOTE:Commmittee Name is different than previously reported
1001 Grand AvenueWest Des Moines, IA 502653502
Email: dpotter@iowamedical.org
2. Date: 03/12/2012
3. FEC Committee ID #: C00003970 This committee is a separate segregated fund. Its connected organization is a Membership OrganizationAffiliated Committees/Organizations
Iowa Medical Society1001 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. R Edward Whitver1001 Grand Avenue
West Des Moines, IA 50265
Title: Interim EVP
Phone # (515) 223-1401
Treasurer:
Gene Lariviere1001 Grand Avenue
West Des Moines, Iowa 502653502
Title: Treasurer
Phone # (515) 223-1401
Designated Agent(s):
Deborah Potter1001 Grand Avenue
West Des Moines, Iowa 50265
Title: Director-Finance
Phone # (515) 223-1401
Banks or Depositories
West BankP.O. Box 65020
West Des Moines, Iowa 502650020