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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-983912

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1. Iowa Medical Society Political Action Committee

    515 E Locust Street
    Suite 400
    Des Moines, IA 50309

    NOTE: Address is different than previously reported

    Email: dpotter@iowamedical.org;dpotter@iowamedical.org

2. Date: 01/15/2015

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

Affiliated Committees/Organizations

Iowa Medical Society
515 E Locust Street
Ste 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
Title: EVP
Phone # (515) 223-1401

Treasurer:

Gene Lariviere
515 E Locust Street
Suite 400
Des Moines, Iowa 503091968
Title: Treasurer
Phone # (515) 223-1401

Designated Agent(s):

Deborah Potter
515 E Locust Street
Suite 400
Des Moines, Iowa 503091968
Title: Director Finance
Phone # (515) 223-1401

Banks or Depositories

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

Signed: Gene Lariviere
Date Signed: 01/15/2015
Official Committee URL: www.iowamedical.org

(End FEC FORM 1)

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