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-430447

1. PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEE

5900 South Western Avenue
Suite 102
Sioux Falls, SD 57108
Email: molly@physicianhospitals.org

2. Date: 08/20/2009

3. FEC Committee ID #: C00394163 This committee is a separate segregated fund. Its connected organization is a
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

PHYSICIAN HOSPITALS OF AMERICA
5900 South Western Avenue
Suite 102
Sioux Falls, South Dakota 57108
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Molly Sandvig
5900 South Western Avenue
Suite 102
Sioux Falls, SD 57108
Title: Executive Director
Phone # (605) 321-3483

Treasurer:

R. Blake Curd
810 E. 23rd Street
Sioux Falls, South Dakota 57105
Title: Treasurer
Phone # (605) 977-6854

Designated Agent(s):

Molly Sandvig
5900 South Western Avenue
Suite 102
Sioux Falls, South Dakota 57108
Title: Executive Director
Phone # (605) 321-3483

Banks or Depositories

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

Signed: R. Blake Curd
Date Signed: 08/20/2009
Official Committee URL: None

FORM TEXT

(End FEC FORM 1)

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