FEC Form 1 for PharMerica Inc. Political Action Committee (PPAC)Form 1 for PharMerica Inc. Political Action Committee (PPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-120481

1. PharMerica Inc. Political Action Committee (PPAC)

3625 Queen Palm Drive
Tampa, FL 33619
Fax: 8133186725
Email: jrawlson@pharmerica.com

2. Date: 05/19/2004

3. FEC Committee ID #: C00397455 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

PharMerica Inc.
3625 Queen Palm Drive
Tampa, Florida 33619
Relationship: Connected Organization
Organization Type: Corporation

AmerisourceBergen Corporation Politica
1300 Morris Drive
Suite 100
Chesterbrook, Pennsylvania 19355
Relationship: Affiliated Political Committee

Custodian of Records:

Jon Rawlson
3625 Queen Palm Drive
Tampa, FL 33619
Title: Secretary
Phone # (813) 318-6571

Treasurer:

John M. Lanier
3625 Queen Palm Drive
Tampa, Florida 33619
Title: Treasurer
Phone # (813) 318-6470

Designated Agent(s):

Dan Dearborn
3625 Queen Palm Drive
Tampa, Florida 33619
Title: Assistant Treasurer
Phone # (813) 318-6308

Banks or Depositories

Bank of America
PO Box 25118
Tampa, Florida 33622

Signed: John M. Lanier
Date Signed: 05/19/2004
Official Committee FAX: 8133186725

(End FEC FORM 1)

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