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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-752001

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1. HAWAII MEDICAL POLITICAL ACTION COMMITTEE

    1360 S. BERETANIA ST.
    #200
    HONOLULU, HI 96814
    Email: jnichols@hma-assn.org

    NOTE: Email address is different than previously reported

2. Date: 07/08/2008

3. FEC Committee ID #: C00001347 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

HAWAII MEDICAL ASSOCIATION
1360 S. BERETANIA ST.
#200
HON, Hawaii 96814
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jessica Nichols
1360 S. Beretania St #200
Honolulu, HI 96814
Title: ACCOUNTING MANAGER
Phone # (808) 536-7702

Treasurer:

Dr. JOHN SPANGLER
1360 S. BERETANIA STREET
#200
HONOLULU, Hawaii 96814
Title: TREASURER
Phone # (808) 536-7702

Designated Agent(s):

Banks or Depositories

CENTRAL PACIFIC BANK
P.O. BOX 3590
HON, Hawaii 96811

Signed: Dr. JOHN SPANGLER
Date Signed: 11/09/2011

(End FEC FORM 1)

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