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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-880108

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1. American Medical Group Association PAC

    1202 Medical Center Lane
    Wilmington, NC 28401
    Email: cchace@wilmingtonhealth.com

2. Date: 12/19/2005

3. FEC Committee ID #: C00408120

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

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Treasurer:

Chasity Chace
1202 Medical Center Lane
Wilmington, North Carolina 284017307
Title: Treasurer
Phone # (910) 341-3384

Designated Agent(s):

Chasity Chace
1202 Medical Center Lane
Wilmington, North Carolina 284017307
Title: Treasurer
Phone # (910) 341-3384

Banks or Depositories

Bank of America
PO Box 25118
Tampa, Florida 336225118

Signed: Chasity Chace
Date Signed: 07/18/2013

(End FEC FORM 1)

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