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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1545722

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1. US Radiology Specialists PAC

    4200 Six Forks Road
    Suite 1000
    Raleigh, NC 27609

    NOTE: Address is different than previously reported

    Email: rogerseb@ballardspahr.com

2. Date: 10/20/2021

3. FEC Committee ID #: C00714303 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

US Radiology Specialists, Inc.
4200 Six Forks Road
Suite 1000
Raleigh, North Carolina 27609
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Emory Rogers
1909 K Street, NW
12th Floor
Washington, DC 20006
Title: Custodian of Records
Phone # (202) 661-7639

Treasurer:

Mark Fortkamp
4200 Six Forks Road
Suite 1000
Raleigh, North Carolina 27609
Title: Treasurer
Phone # (312) 533-8028

Designated Agent(s):

Banks or Depositories

Bank of America
1801 K Street, NW
Washington, DC 20006

Signed: Mark Fortkamp
Date Signed: 10/20/2021

FORM TEXT-1

(End FEC FORM 1)

Generated Sat Oct 19 03:36:36 2024