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-942996

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: 07/25/2014

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

Affiliated Committees/Organizations

Superior Air Ground Ambulance Service Inc.
395 W. 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:

Francis J. Leonard
395 W. Lake Street
Elmhurst, Illinois 60126
Title: CEO
Phone # (630) 903-2401

Designated Agent(s):

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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-942996

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

2. Date: 07/25/2014

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Francis J. Leonard
Date Signed: 07/25/2014

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-942996

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

2. Date: 07/25/2014

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Francis J. Leonard Date Signed: 07/25/2014

(End FEC FORM 1)

Signed: Francis J. Leonard
Date Signed: 07/25/2014