FEC Form 1 for Ohio Medical Political Action CommitteeForm 1 for Ohio Medical Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-150752

1. Ohio Medical Political Action Committee

3401 Mill Run Drive
Hilliard, OH 43026
Fax: 6145276763
Email: ompac@osma.org

2. Date: 10/11/2004

3. FEC Committee ID #: C00003327 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00407569
Columbus Medical Association Political Action Committee
431 East Broad Street
Columbus, Ohio 43215
Relationship: Affiliated

Ohio State Medical Association
3401 Mill Run Drive
Hilliard, Ohio 43026
Relationship: Connected
Organization Type: Membership Organization

Committee ID# C00000422
American Medical Association PAC
1101 Vermont Avenue NW
Washington, DC 20005
Relationship: Affiliated

Custodian of Records:

Timothy Maglione
3401 Mill Run Drive
Hilliard, OH 43026

Treasurer:

Timothy Maglione
3401 Mill Run Drive
Hilliard, Ohio 43026

Designated Agent(s):

Timothy Maglione
3401 Mill Run Drive
Hilliard, Ohio 43026
Title: Treasurer
Phone # (614) 527-6762

Banks or Depositories

Bank One
Bank One NA
Dept 1045
Columbus, Ohio 432711045

Signed: Timothy Maglione
Date Signed: 11/10/2004
Official Committee FAX: 6145276763

(End FEC FORM 1)

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