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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 2

DR-1 Statement of Organization

515-288-1955Phone:

100 East Grand Avenue, Suite 100Address:

City: Des Moines State: IA 50309-1800Zip Code:

Iowa Hospital AssociationName:

E-Mail: spiesa@ihaonline.org

Parent Entity

641-792-3010Phone:

Last Name: Kahn First Name: Gary MI:

Skiff Med Ctr/First Newton BankAddress: 100 N 2nd Ave W

City: Newton State: IA 50208Zip Code:

E-Mail: gkahn@firstnnb.com

Committee Chairperson

515-288-1955Phone:

Last Name: Norris First Name: J. Kirk MI:

IHAAddress: 100 East Grand Ave., Ste. 100

City: Des Moines State: IA 50309-1800Zip Code:

E-Mail: norrisk@ihaonline.org

Treasurer

District: 0

County: Polk

Committee Name: IHA PACIowa PACCommittee Type:

Status: Amended Date: 5/15/2008

Political Party: Not Available

Committee Code: 6291

IHA PACType: Checking

Wells Fargo Bank666 Walnut Street Des Moines, IA 50309

Account Name Bank

Bank Accounts

Purpose

See Paragraph IV of IHA PAC Principles of Organization

DR-1IndexedAuditedComputer

Year Standing for Election:

Date of Election: 12/30/1899

Iowa PACs (Non Partisan)Office Sought:

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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 2 of 2

Statement of Affirmation By Treasurer and Candidate; or Political Committees, By Chairperson

STATEMENT OF AFFIRMATION: By filing this document the committee affirms the following

1. The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 68Band the administrative rules in Chapter 351 of the Iowa Administrative Code.2. That Iowa Code section 68A.6 and rule 351-4.9 require the filing of disclosure reports and that failure to file these reports on or before therequired due dates subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the automaticassessment of a civil penalty and the possible imposition of other criminal and civil sanctions.3. That Iowa Code section 68A.14 and rules 351-4.38 through 4.43 require the placement of the words "paid for by" and the name of the

committee on all political materials except for those items exempted by statute or rule.4. That Iowa Code section 68A.15 and rules 351-4.44 through 4.52 prohibit the receipt of corporate contributions by all committees except forstatewide and local ballot issue PACs.5. A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68A.40 through 68A.42 andrule 351-4.25.6. That the committee will continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final reportand a statement of dissolution (DR-3) has been filed.

Candidate: Treasurer:(signature and date) (signature and date)