8/7/2019 IAHU PAC_9813_DR1_09-29-2010

http://slidepdf.com/reader/full/iahu-pac9813dr109-29-2010 1/2

Generated On: 9/29/2010 4:15:06 PM

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

515-689-2809Phone:

PMB 134Address: 4949 Westown Pkwy, Suite 165

City: West Des Moines State: IA 50266Zip Code:

Iowa Association of Health UnderwritersName:

E-Mail: execdir@eiahu.org

Parent Entity

515-225-9995Phone:

Last Name: Van Ahn First Name: David MI:

PMB 134Address: 4949 Westown Pkwy, Suite 165

City: West Des Moines State: IA 50266Zip Code:

E-Mail: dvanahn@heartland-insgroup.com

Committee Chairperson

515-231-5593Phone:

Last Name: Strouse First Name: Marcie MI:

PMB 134Address: 4949 Westown Pkwy, Suite 165

City: West Des Moines State: IA 50266Zip Code:

E-Mail: mstrouse@focusonesource.com

Treasurer

District: 0

County: _NA

Committee Name: IAHU PAC

Iowa PACCommittee Type:

Status: Amended Date: 9/29/2010

Political Party: Not Available

Committee Code: 9813

IAHU PACType: Checking

Freedom Financial Bank1255 Jordan Creek Pkwy West Des Moines, IA 50266

Account Name Bank

Bank Accounts

Purpose

To advocate for candidates

DR-1Indexed

Audited

Computer

Year Standing for Election: 2010

Date of Election:

Office Sought:

8/7/2019 IAHU PAC_9813_DR1_09-29-2010

http://slidepdf.com/reader/full/iahu-pac9813dr109-29-2010 2/2

Generated On: 9/29/2010 4:15:06 PM

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 following1. 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)