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-473298

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

4965 US Highway 42
Suite 2000
Louisville, KY 40222
Email: kppac@kyma.org

2. Date: 06/03/2010

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

Affiliated Committees/Organizations

Kentucky Medical Association
4965 US Highway 42
Suite 2000
Louisville, Kentucky 402226379
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Laura Hartz
4965 US Hwy 42
Suite 2000
Louisville, KY 402226379
Title: Custodian of Records
Phone # (502) 426-6200

Treasurer:

David R Watkins, MD
4965 US Hwy 42, Suite 2000
Louisville, Kentucky 402226379
Title: Treasurer
Phone # (502) 426-6200

Designated Agent(s):

Banks or Depositories

PNC Bank
, ____ 0.00

PNC Bank
, ____

Signed: David R Watkins, MD
Date Signed: 06/03/2010
Official Committee URL: http://www.kyphysicianspac.org

FORM TEXT

(End FEC FORM 1)

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