FEC Form 1 for SOCIETY OF INTERVENTIONAL RADIOLOGY POLITICAL ACTION COMMITTEEForm 1 for SOCIETY OF INTERVENTIONAL RADIOLOGY POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1343898

1. SOCIETY OF INTERVENTIONAL RADIOLOGY POLITICAL ACTION COMMITTEE

3975 Fair Ridge Dr.
Suite 400 North
FAIRFAX, VA 22033
Email: jbuckalew@sirweb.org;jlee@sirweb.org

NOTE: Email address is different than previously reported

2. Date: 07/25/2019

3. FEC Committee ID #: C00408435 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Society of Interventional Radiology
3975 Fair Ridge Drive, Ste 400 N
Fairfax, Virginia 22033
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jeff Nielsen
3975 Fair Ridge Drive, Ste 400 N
Fairfax, VA 22033
Title: Director, Finance
Phone # (703) 691-1805

Treasurer:

Jeff Nielsen
3975 Fair Ridge Drive, Ste 400 N
Fairfax, Virginia 22033
Title: Director, Finance
Phone # (703) 691-1805

Designated Agent(s):

Ji Youn Lee
3975 Fair Ridge Dr.
Suite 400N
Fairfax, Virginia 22033
Title: Staff Accountant
Phone # (703) 691-1805

Jeff Nielsen
3975 Fair Ridge Drive, Ste 400 N
Fairfax, Virginia 22033
Title: Director, Finance
Phone # (703) 691-1805

Judi Buckalew
3975 Fair Ridge Dr
Suite 400N
Fairfax, Virginia 22033
Title: Director Govt Affair
Phone # (703) 691-1805

Banks or Depositories

Bank of America
PO Box 27025
Richmond, Virginia 23261

Signed: Jeff Nielsen
Date Signed: 07/25/2019
Official Committee URL: www.sirweb.org

(End FEC FORM 1)

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