FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-157137
1. OREGON MEDICAL POLITICAL ACTION COMMITTEE
5210 SW CORBETT AVENUEPORTLAND, OR 972393897
Fax: 5032417148
Email: sarita@theoma.org
2. Date: 12/28/2004
3. FEC Committee ID #: C00035766 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Committee ID# C00000422AMPAC
1101 VERMONT AVENUE NW
12TH FLOOR
WASHINGTON, DC 20005
Relationship: Affiliated
Organization Type: Membership Organization
Custodian of Records:
Sarita MarfinOMA
5210 SW Corbett Ave
Portland, OR 97239
Title: Assistant
Phone # (503) 595-5151
Treasurer:
DAVID COUTINOREGON MEDICAL ASSOCIATION
5210 SW CORBETT AVENUE
PORTLAND, Oregon 97239
Title: Treasurer
Phone # (503) 226-1555
Designated Agent(s):
Banks or Depositories
US BankPOB 1800
St Paul, Minnesota 551010800