FEC Form 1 for Wisconsin Medical Society Political Action CommitteeForm 1 for Wisconsin Medical Society Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1164148

1. Wisconsin Medical Society Political Action Committee

330 E. Lakeside Street
Madison, WI 53715
Email: heidi.green@wismed.org

2. Date: 05/12/2017

3. FEC Committee ID #: C00548438 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

American Medical Politcal Action Committee (AMPAC)
25 Massachusetts Ave NW
Suite 600
Washington, DC 20001
Affiliated Relationship Code: Affiliated Committee

Wisconsin Medical Society
330 E Lakeside Street
Madison, Wisconsin 53715
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms. Lauren Rusch
330 E Lakeside Street
Madison, WI 53715
Title: Accountant
Phone # (608) 442-3744

Treasurer:

Ms. Heidi Green
330 E. Lakeside Street
Madison, Wisconsin 53715
Title: Political Action & L
Phone # (608) 442-3720

Designated Agent(s):

Heidi Green
330 E Lakeside St
Madison, Wisconsin 53715

Banks or Depositories

Johnson Bank
5133 West Terrace Dr
PO Box 8636
Madison, Wisconsin 53708

Signed: Ms. Heidi Green
Date Signed: 05/12/2017

FORM TEXT-1

(End FEC FORM 1)

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