FEC Form 1 for PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEEForm 1 for PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-314726

1. PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEE

NOTE:Commmittee Name is different than previously reported

2600 South Minnesota Avenue
Suite 202
Sioux Falls, SD 57105

NOTE: Address is different than previously reported

Fax: 6057312575
Email: molly@physicianhospitals.org

2. Date: 01/09/2008

3. FEC Committee ID #: C00394163 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

PHYSICIAN HOSPITALS OF AMERICA
2600 South Minnesota Avenue
Suite 202
Sioux Falls, South Dakota 57105
Relationship: Connected Org.
Organization Type: Trade Association

Custodian of Records:

Molly Sandvig
2600 South Minnesota Avenue
Suite 202
Sioux Falls, SD 57105
Title: Executive Director
Phone # (605) 321-3483

Treasurer:

Douglas Johnson
600 S. Cliff Ave.
Suite 106
Sioux Falls, South Dakota 571045355
Title: Treasurer
Phone # (605) 321-3483

Designated Agent(s):

Molly Sandvig
2600 South Minnesota Avenue
Suite 202
Sioux Falls, South Dakota 57105
Title: Executive Director
Phone # (605) 321-3483

Banks or Depositories

Wells Fargo Bank
P.O. Box 5128
Sioux Falls, South Dakota 571175128

Signed: Douglas Johnson
Date Signed: 01/09/2009
Official Committee FAX: 6057312575

(End FEC FORM 1)

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