FEC Form 1 for Physician Insurers Association of America Political Action CommitteeForm 1 for Physician Insurers Association of America Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-269857

1. Physician Insurers Association of America Political Action Committee

2275 Research Blvd
Suite 250
Rockville, MD 20850
Fax: 3019479090
Email: mstinson@piaa.us

2. Date: 01/18/2007

3. FEC Committee ID #: C00319319 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Physician Insurers Association of America
2275 Research Boulevard
Suite 250
Rockville, Maryland 20850
Relationship: Connected
Organization Type: Trade Association

Custodian of Records:

Michael C Stinson
2275 Research Blvd.
Suite 250
Rockville, MD 20850
Title: Assistant Treasurer
Phone # (301) 947-9000

Treasurer:

Lawrence E Smarr
2275 Research Boulevard
Suite 250
Rockville, Maryland 20850
Title: Treasurer
Phone # (301) 947-9000

Designated Agent(s):

Michael C Stinson
2275 Research Blvd.
Suite 250
Rockville, Maryland 20850
Title: Assistant Treasurer
Phone # (301) 947-9000

Banks or Depositories

Merrill Lynch
1040 Stoney Hill Road
Suite 150
Yardley, Pennsylvania 19067

Signed: Lawrence E Smarr
Date Signed: 01/18/2007
Official Committee FAX: 3019479090

(End FEC FORM 1)

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