FEC Form 1 for OREGON MEDICAL POLITICAL ACTION COMMITTEEForm 1 for OREGON MEDICAL POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-119431

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: 04/05/2004

3. FEC Committee ID #: C00035766 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00000422
AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE
1101 VERMONT AVENUE NW
12TH FLOOR
WASHINGTON, DC 20005
Relationship: Affiliated
Organization Type: Membership Organization

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):

Banks or Depositories

US Bank
POB 1800
St Paul, Minnesota 551010800

Signed: Dr. Martin Skinner
Date Signed: 05/12/2004
Official Committee FAX: 5032417148

(End FEC FORM 1)

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