FEC Form 1 for American College of Radiology AssociationForm 1 for American College of Radiology Association

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-86567

1. American College of Radiology Association

NOTE:Commmittee Name is different than previously reported

1891 Preston White Drive
Reston, VA 201914397
Fax: 703-262-9312
Email: hengd@acr.org

2. Date: 05/27/2003

3. FEC Committee ID #: C00343459 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American College of Radiology Association
1891 Preston White Drive
Reston, Virginia 20191
Relationship: sponored organization
Organization Type: Membership Organization

Custodian of Records:

Phone # 0

Treasurer:

Arl Van Moore, M.D.
1817 Craigmore Drive
Charlotte, North Carolina 28226
Title: Treasurer Radiologi
Phone # (704) 355-2274

Designated Agent(s):

Lisa Parker Gates
JB Corporation Services
One IBM Plaza
Chicago, Illinois 60611
Phone number = 0

Banks or Depositories

Signed: Arl Van Moore, M.D.
Date Signed: 06/09/2003
Official Committee FAX: 703-262-9312

FORM TEXT

(End FEC FORM 1)

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