FEC Form 1 for Nebraska Chiropractic Physicians Association Political Action CommitteeForm 1 for Nebraska Chiropractic Physicians Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-803273

1. Nebraska Chiropractic Physicians Association Political Action Committee

13215 Birch Drive
Suite 200
Omaha, NE 68164
Email: pneal@ncpa.net;jmorey@ncpa.net

NOTE: Email address is different than previously reported

2. Date: 08/07/2012

3. FEC Committee ID #: C00043471 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Committee ID# C00043471
Nebraska Chiropractic Physicians Association Political Action Committee
13215 Birch Drive
Suite 200
Omaha, Nebraska 68164
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Penny Neal
13215 Birch Drive
Suite 200
Omaha, NE 68164
Title: Assistant Controller
Phone # (402) 934-4744

Treasurer:

Dr. Jeff Freeman
2640 E Street
Lincoln, Nebraska 68510

Designated Agent(s):

Louis Andersen
13215 Birch Drive
Suite 200
Omaha, Nebraska 68164
Title: CEO
Phone # (402) 934-4744

Banks or Depositories

Omaha State Bank
12100 West Center Road
Omaha, Nebraska 68144

Signed: Dr. Jeff Freeman
Date Signed: 08/07/2012
Official Committee URL: http://www.nechiropractic.org

(End FEC FORM 1)

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