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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-108211

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1. OREGON MEDICAL POLITICAL ACTION COMMITTEE

    5210 SW CORBETT AVENUE
    PORTLAND, OR 972393897

    NOTE: Address is different than previously reported

    Fax: 5032417148
    Email: sarita@theoma.org

2. Date: 02/13/2004

3. FEC Committee ID #: C00035766 This committee supports/opposes only one candidate and is NOT an Authorized Committee. Candidate Name:

Affiliated Committees/Organizations

Custodian of Records:

Sarita Marfin
OMA
5210 SW Corbett Ave
Portland, OR 97239
Title: Assistant
Phone # (503) 595-5151

Treasurer:

Dr. Martin Skinner
OMA
5210 SW Corbett Av, Oregon 97239
Title: Treasurer
Phone # (503) 226-1555

Designated Agent(s):

Dr. Skinner Martin
OMA
5210 SW Corbett Ave
Portland, Oregon 97239
Title: Treasurer
Phone # (503) 226-1555

Banks or Depositories

US Bank
POB 1800
St Paul, Minnesota 551010800

Signed: Dr. Martin Skinner
Date Signed: 02/12/2003
Official Committee FAX: 5032417148

(End FEC FORM 1)

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