FEC Form 1 for SUPERIOR AIR-GROUND AMBULANCE SERVICE INC EMPLOYEES PAC (SUPERIOR AMBULANCE EMPLOYEES PForm 1 for SUPERIOR AIR-GROUND AMBULANCE SERVICE INC EMPLOYEES PAC (SUPERIOR AMBULANCE EMPLOYEES P

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1437827

1. SUPERIOR AIR-GROUND AMBULANCE SERVICE INC EMPLOYEES PAC (SUPERIOR AMBULANCE EMPLOYEES P

395 WEST LAKE STREET
ELMHURST, IL 60126
Email: kgodden@superiorambulance.com;mjorgensen@superiorambulance.com

2. Date: 09/15/2020

3. FEC Committee ID #: C00545558 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00545558
SUPERIOR AIR-GROUND AMBULANCE SERVICE INC EMPLOYEES PAC (SUPERIOR AMBULANCE EMPLOYEES P
395 WEST LAKE STREET
ELMHURST, Illinois 60126
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Kimberly Pate Godden
2135 W. Walton Street
Chicago, IL 60622
Title: Vice President
Phone # (630) 903-2401

Treasurer:

Darren Frasca
395 W. Lake Street
Elmhurst, Illinois 60126
Title: VP of Finance
Phone # (630) 903-2228

Designated Agent(s):

Kimberly Pate Godden
2135 W. Walton Street
Chicago, Illinois 60622
Title: Vice President
Phone # (630) 903-2401

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1437827

1. SUPERIOR AIR-GROUND AMBULANCE SERVICE INC EMPLOYEES PAC (SUPERIOR AMBULANCE EMPLOYEES P

2. Date: 09/15/2020

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Darren Frasca
Date Signed: 09/15/2020

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1437827

1. SUPERIOR AIR-GROUND AMBULANCE SERVICE INC EMPLOYEES PAC (SUPERIOR AMBULANCE EMPLOYEES P

2. Date: 09/15/2020

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Darren Frasca Date Signed: 09/15/2020

(End FEC FORM 1)

Signed: Darren Frasca
Date Signed: 09/15/2020