FEC Form 1 for California Medical Association Political Action Committee - FederalForm 1 for California Medical Association Political Action Committee - Federal

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1164187

1. California Medical Association Political Action Committee - Federal

555 Capitol Mall, Suite 1425
Sacramento, CA 95814
Email: info@olsonhagel.com

2. Date: 05/25/2017

3. FEC Committee ID #: C00003194 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Committee ID# C00000422
American Medical Association Political Action Committee
25 Massachusetts Ave. NW Ste 600
Washington, DC 20001
Affiliated Relationship Code: Affiliated Committee

California Medical Association
1201 J Street, Suite 200
Sacramento, California 95814
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Richard R. Rios
555 Capitol Mall, Suite 1425
Sacramento, CA 95814
Title: Custodian of Records
Phone # (916) 442-2952

Treasurer:

Damodara Rajasekhar, MD
18182 U.S. Highway 18, Suite 103
Apple Valley, California 92307
Title: Treasurer
Phone # (916) 444-5532

Designated Agent(s):

Nicholas Birtcil
1201 J Street, Suite 200
Sacramento, California 95814
Title: Assistant Treasurer
Phone # (916) 444-5532

Nicholas Birtcil
1201 J Street, Suite 200
Sacramento, California 95814
Title: POF
Phone # (916) 444-5532

Banks or Depositories

First Citizens Bank
455 Capitol Mall
Sacramento, California 95814

Union Bank
700 L Street
Sacramento, California 95814

Signed: Nicholas Birtcil
Date Signed: 05/24/2016

(End FEC FORM 1)

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