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-1580671

1. Wisconsin Medical Society Political Action Committee

2920 Marketplace Drive, Suite 103
Fitchburg, WI 53719

NOTE: Address is different than previously reported

Email: heidi.green@wismed.org

2. Date: 04/12/2022

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

Affiliated Committees/Organizations

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

Custodian of Records:

Ms. Deborah Muresan
2920 Marketplace Drive, Suite 103
Fitchburg, WI 53719
Title: Controller
Phone # (608) 442-3711

Treasurer:

Ms. Heidi Green
2920 Marketplace Drive, Suite 103
Fitchburg, Wisconsin 53719
Title: Political Action & L
Phone # (608) 442-3720

Designated Agent(s):

Heidi Green
2920 Marketplace Drive, Suite 103
Fitchburg, Wisconsin 53719

Banks or Depositories

Johnson Bank
5133 West Terrace Drive
P. O. Box 8636
Madison, Wisconsin 53708

Signed: Ms. Heidi Green
Date Signed: 04/12/2022

FORM TEXT-1

(End FEC FORM 1)

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