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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-235854

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1. Wake Emergency Physicians PA PAC

    570 New Waverly Place
    Suite 210
    Cary, NC 27518
    Fax: 9198593122
    Email: weppa@weppa.org

2. Date: 07/17/2006

3. FEC Committee ID #: C00412841 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Wake Emergency Physicians PA
570 New Waverly Place
Suite 210
Cary, North Carolina 27518
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Daniel Adam Staniszewski
570 New Waverly Place
Suite 210
Cary, NC 27518
Title: Director of Acctg
Phone # (919) 859-3373

Treasurer:

Michael Talmadge Brohawn
570 New Waverly Place
Suite 210
Cary, North Carolina 27518
Title: Administrator
Phone # (919) 859-3373

Designated Agent(s):

Banks or Depositories

Signed: Michael Talmadge Brohawn
Date Signed: 08/28/2006
Official Committee FAX: 9198593122

(End FEC FORM 1)

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