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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1420456

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1. ROTHMAN INSTITUTE PAC

    925 CHESTNUT STREET
    PHILADELPHIA, PA 19107
    Email: paul.courtney@rothmanortho.com;adam@boninlaw.com

    NOTE: Email address is different than previously reported

2. Date: 07/13/2020

3. FEC Committee ID #: C00558700 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Rothman Institute
925 Chestnut Street
Philadelphia, Pennsylvania 19107
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Dr. Paul Maxwell Courtney
925 Chestnut St
FL 5
Philadelphia, PA 19107
Title: Treasurer
Phone # (484) 994-3123

Treasurer:

Dr. Paul Maxwell Courtney
925 Chestnut St
FL 5
Philadelphia, Pennsylvania 19107
Title: Treasurer
Phone # (484) 994-3123

Designated Agent(s):

Banks or Depositories

Mellon Bank
1735 Market Street
Phila, Pennsylvania 19103

Signed: Dr. Paul Maxwell Courtney
Date Signed: 07/14/2020

(End FEC FORM 1)

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