FEC Form 1 for American Association of Neurological Surgeons Political Action Committee (NeurosurgeryPAC)Form 1 for American Association of Neurological Surgeons Political Action Committee (NeurosurgeryPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-236176

1. American Association of Neurological Surgeons Political Action Committee (NeurosurgeryPAC)

NOTE:Commmittee Name is different than previously reported

725 Fiftheenth St. NW Suite 800
Washington, DC 20005

2. Date: 08/30/2006

3. FEC Committee ID #: C00413955 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American Association of Neurological Surgeons
5550 Meadowbrook
Rolling Meadows, Illinois 60007
Relationship: Connected
Organization Type: Trade Association

Custodian of Records:

Dr. James R Bean
1401 Harrodsburg Rd
Ste. 485
Lexington, KY 405043797
Title: Treasurer
Phone # (859) 260-2721

Treasurer:

Dr. James R Bean
1401 Harrodsburg Rd
Ste. 485
Lexington, Kentucky 405043797
Title: Treasurer
Phone # (859) 260-2721

Designated Agent(s):

Ronald W. Engelbreit
5550 Meadowbrook
Rolling Meadows, Illinois 60007
Title: Assistant Treasurer
Phone # (847) 378-0509

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-236176

1. American Association of Neurological Surgeons Political Action Committee (NeurosurgeryPAC)

NOTE:Commmittee Name is different than previously reported

2. Date: 08/30/2006

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Dr. James R Bean
Date Signed: 08/30/2006

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-236176

1. American Association of Neurological Surgeons Political Action Committee (NeurosurgeryPAC)

NOTE:Commmittee Name is different than previously reported

2. Date: 08/30/2006

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Dr. James R Bean Date Signed: 08/30/2006

(End FEC FORM 1)

Signed: Dr. James R Bean
Date Signed: 08/30/2006