FEC Form 1 for Health Insurance Political Action Committee of the Health Insurance Association of AmericaForm 1 for Health Insurance Political Action Committee of the Health Insurance Association of America

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-112994

1. Health Insurance Political Action Committee of the Health Insurance Association of America

1129 20th St. NW
Suite 600
Washington, DC 20036
Fax: 202-955-4397

2. Date: 10/21/2003

3. FEC Committee ID #: C00110494 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

AAHP/HIAA PAC
601 Penn. Ave. NW #500 So. Bldg.
Washington, DC 20004
Relationship: Affiliated Committee

Custodian of Records:

Treasurer:

Stephen W. Robertson
1129 20th Street NW
#600
Washington, DC 20036
Title: Senior Vice Presiden
Phone # (202) 778-3200

Designated Agent(s):

Banks or Depositories

Bank of America
730 15th Street NW
Washington, DC 20005

Signed: Stephen Robertson
Date Signed: 03/26/2004
Official Committee FAX: 202-955-4397

(End FEC FORM 1)

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