FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-747492
1. WISCONSIN HOSPITAL ASSOCIATION INC FEDERAL PAC DBA WISCONSIN HOSPITAL ASSOC FEDERAL PAC
PO BOX 2590385510 Research Park Drive
Madison, WI 537259038
Email: bpotter@wha.org
NOTE: Email address is different than previously reported
2. Date: 10/11/2011
3. FEC Committee ID #: C00422881 This committee is a separate segregated fund. Its connected organization is a Trade AssociationIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
Wisconsin Hospital AssociationPO Box 259038
5510 Research Park Drive
Madison, Wisconsin 537259038
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Treasurer:
Mr. Brian Potter5510 Research Park Drive
PO Box 259038
Madison, Wisconsin 537259038
Title: VP, Finance/Operatio
Phone # (608) 274-1820
Designated Agent(s):
Banks or Depositories
M&I Marshall and Ilsley Bank401 North Segoe Road
Madison, Wisconsin 537053106