FEC Form 1 for HEARTLAND COMMUNITY BANKERS ASSOCIATION-POLITICAL ACTION COMMITTEE (HCBA-PAC)Form 1 for HEARTLAND COMMUNITY BANKERS ASSOCIATION-POLITICAL ACTION COMMITTEE (HCBA-PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-883709

1. HEARTLAND COMMUNITY BANKERS ASSOCIATION-POLITICAL ACTION COMMITTEE (HCBA-PAC)

212 SW 8th Avenue, Suite 200
TOPEKA, KS 66603
Email: judyk@hcbankers.com

NOTE: Email address is different than previously reported

2. Date: 08/01/2013

3. FEC Committee ID #: C00160978 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Heartland Community Bankers Association
212 SW 8th Avenue
Suite 200
Topeka, Kansas 66603
Affiliated Relationship Code: Connected Organization

American Bankers Association PAC
1120 Connecticut Ave NW
Suite 600
Washington, DC 20036
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Judy Knoll
212 SW 8th Avenue, Suite 200
Topeka, KS 66603
Title: Bookkeeper
Phone # (785) 232-8215

Treasurer:

John C. Dicus
1524 Lakeside Dr
Topeka, Kansas 66604
Title: Treasurer
Phone # (785) 232-8215

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-883709

1. HEARTLAND COMMUNITY BANKERS ASSOCIATION-POLITICAL ACTION COMMITTEE (HCBA-PAC)

NOTE: Email address is different than previously reported

2. Date: 08/01/2013

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: John C. Dicus
Date Signed: 08/01/2013

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-883709

1. HEARTLAND COMMUNITY BANKERS ASSOCIATION-POLITICAL ACTION COMMITTEE (HCBA-PAC)

NOTE: Email address is different than previously reported

2. Date: 08/01/2013

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: John C. Dicus Date Signed: 08/01/2013

(End FEC FORM 1)

Signed: John C. Dicus
Date Signed: 08/01/2013