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-24741

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

1201 F Street NW
Suite 500
Washington, DC 20004

2. Date: 01/28/2002

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

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Christopher Bowlin
1201 F Street NW
Suite 500
Washington, DC 20004
Phone # (202) 824-1600

Designated Agent(s):

Banks or Depositories

Signed: Mr. Christopher Bowlin
Date Signed: 01/29/2002

(End FEC FORM 1)

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