FEC Form 1 for American Association of Physician Specialists Inc. Politician Action Committee (AAPSPAC)Form 1 for American Association of Physician Specialists Inc. Politician Action Committee (AAPSPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-311445

1. American Association of Physician Specialists Inc. Politician Action Committee (AAPSPAC)

5550 W. Executive Drive Suite 400
Tampa, FL 33609
Email: bshuford@aapsus.org

2. Date: 11/20/2007

3. FEC Committee ID #: C00331017 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

William J. Carbone
5550 Executive Dr Suite 400
Tampa, FL 33609
Title: Custodian

Treasurer:

Stephen Montes
701 West Wedgewood
Muskegon, Michigan 49445
Title: Treasurer
Phone # (616) 773-3238

Designated Agent(s):

Steven Carin
40 Grosvenor Hall
Athens, Ohio 45701
Title: Assistant Treasurer
Phone # (740) 594-4722

Banks or Depositories

Bank of America
PO Box 25118
Tampa, Florida 33622

Signed: Stephen Montes
Date Signed: 11/20/2007

(End FEC FORM 1)

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