FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-858710
1. Wake Emergency Physicians, PA PAC
570 New Waverly PlaceSuite 210
Cary, NC 27518
Email: brohawn@weppa.org
2. Date: 12/12/2006
3. FEC Committee ID #: C00412841 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Wake Emergency Physicians, PA570 New Waverly Place
Suite 210
Cary, North Carolina 27518
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Daniel Adam Staniszewski570 New Waverly Place
Suite 210
Cary, NC 27518
Title: Director of Acctng
Phone # (919) 859-3373
Treasurer:
Michael Talmadge Brohawn570 New Waverly Place
Suite 210
Cary, North Carolina 27518
Title: Administrator
Phone # (919) 859-3373
Designated Agent(s):
Banks or Depositories
Wachovia Bank150 Fayetteville Street Mall
Raleigh, North Carolina 27602