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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-304714

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1. OREGON MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE

    11740 SW 68TH PARKWAY
    SUITE 100
    PORTLAND, OR 972239038

    NOTE: Address is different than previously reported

    Fax: 5036190609
    Email: jen@theoma.org

2. Date: 06/01/2006

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

Affiliated Committees/Organizations

Oregon Medical Association
11740 SW 68th Parkway
Portland, Oregon 97223
Relationship: Connected
Organization Type: Membership Organization

Custodian of Records:

Jennifer Marie Lewis
11740 SW 68th Parkway Suite 100
Portland, OR 97223
Title: Admin Assistant
Phone # (503) 619-8000

Treasurer:

SCOTT GALLANT
Oregon Medical Association
11740 SW 68th Parkway
Portland, Oregon 97223
Title: Treasurer OMPAC
Phone # (503) 619-8000

Designated Agent(s):

Banks or Depositories

US BANK
POB 1800
ST PAUL, Minnesota 551010800

Signed: SCOTT GALLANT
Date Signed: 09/26/2007
Official Committee FAX: 5036190609

(End FEC FORM 1)

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