FEC Form 1 for Kentucky Medical Association PAC (Kentucky Physicians PAC Federal-KPPAC Federal)Form 1 for Kentucky Medical Association PAC (Kentucky Physicians PAC Federal-KPPAC Federal)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1104164

1. Kentucky Medical Association PAC (Kentucky Physicians PAC Federal-KPPAC Federal)

9300 Shelbyville Road
Suite 800
Louisville, KY 40222

NOTE: Address is different than previously reported

Email: kppac@kyma.org

2. Date: 10/11/2016

3. FEC Committee ID #: C00016444 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Kentucky Medical Association
9300 Shelbyville Road
Suite 800
Louisville, Kentucky 40222
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Laura Hartz
9300 Shelbyville Road
Suite 800
Louisville, KY 40222
Title: Custodian of Records
Phone # (502) 426-6200

Treasurer:

Monalisa Tailor, MD
9300 Shelbyville Road
Suite 800
Louisville, Kentucky 40222

Designated Agent(s):

Banks or Depositories

PNC Bank
2500 Lime Kiln Lane
Louisville, Kentucky 40222

PNC Bank
2500 Lime Kiln Lane
Louisville, Kentucky 40222

Signed: Monalisa Tailor, MD
Date Signed: 10/11/2016
Official Committee URL: http://www.kppac.org

(End FEC FORM 1)

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