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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409695

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1. PHYSICIAN INSURERS ASSOCIATION OF AMERICA POLITICAL ACTION COMMITTEE (PIAAPAC)

    NOTE:Commmittee Name is different than previously reported

    2275 Research Blvd
    Suite 250
    Rockville, MD 20850
    Email: seastman@piaa.us

2. Date: 03/25/2009

3. FEC Committee ID #: C00319319 This committee is a separate segregated fund. Its connected organization is a Trade Association
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Committee ID# C00319319
PHYSICIAN INSURERS ASSOCIATION OF AMERICA POLITICAL ACTION COMMITTEE (PIAAPAC)
2275 Research Blvd
Suite 250
Rockville, Maryland 20850
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Sheryl Eastman
2275 Research Blvd., Ste. 250
Rockville, MD 20850
Title: Administrative Asst.
Phone # (301) 947-9000

Treasurer:

Mr. Lawrence E. Smarr
14600 Poplar Hill Rock
Germantown, Maryland 20874
Title: Treasurer
Phone # (301) 947-9000

Designated Agent(s):

Mr. Mike Stinson
3006 Bryan St.
Alexandria, Virginia 22302
Title: Assistant Treasurer
Phone # (301) 947-9000

Banks or Depositories

Merrill Lynch
1040 Stoney Hill Road, Ste. 1050
Yardley, Pennsylvania 19067

Signed: Mr. Mike Stinson
Date Signed: 03/25/2009

(End FEC FORM 1)

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