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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-761144

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1. GIPAC

    1950 Roland Clarke Place Suite 300
    Reston, VA 20191
    Email: fecinfo@pass1.com

2. Date: 01/30/2012

3. FEC Committee ID #: C00354571

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

Custodian of Records:

W. Elwyn Lyles
c/o PASS 1950 Roland Clarke Drive
Suite 300
Reston, VA 20191
Title: Custodian of Records
Phone # (703) 476-3070

Treasurer:

W. Elwyn Lyles
c/o PASS 1950 Roland Clarke Drive
Suite 300
Reston, Virginia 20191
Title: Treasurer
Phone # (703) 476-3070

Designated Agent(s):

Vincent Tallman
1950 Roland Clarke Place Suite 300
Reston, Virginia 20191
Title: Assistant Treasurer
Phone # (703) 476-3070

Banks or Depositories

Bank of America NA
P.O. Box 27025
Richmond, Virginia 23261

Signed: W. Elwyn Lyles, M.D., FACG
Date Signed: 01/30/2012
Official Committee URL: www.gipac.org

FORM TEXT

(End FEC FORM 1)

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