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-283360

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

NOTE:Commmittee Name is different than previously reported

4965 US Highway 42 Suite 2000
Louisville, KY 40222
Fax: 502-326-2696
Email: kppac@kyma.org

2. Date: 03/01/2002

3. FEC Committee ID #: C00016444 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Katie Rafferty
Suite 2000
4965 US Highway 42
Louisville, KY 40222
Title: Custodian
Phone # (502) 426-6200

Treasurer:

Susan G. Bornstein MD
Suite 2000
4965 US Highway 42
Louisville, Kentucky 40222
Title: Treasurer
Phone # (502) 426-6200

Designated Agent(s):

Banks or Depositories

PNC Bank
Louisville, Kentucky 40222

Signed: Susan G. Bornstein MD
Date Signed: 04/09/2007
Official Committee URL: kyma.org
Official Committee FAX: 502-326-2696

(End FEC FORM 1)

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