FEC Form 1 for Mid Atlantic Medical Services Inc. PACForm 1 for Mid Atlantic Medical Services Inc. PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-112804

1. Mid Atlantic Medical Services Inc. PAC

4 Taft Court
Rockville, MD 20850
Fax: 3015455385
Email: danwilloth@mamsi.com

2. Date: 03/22/2004

3. FEC Committee ID #: C00267245 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00231407
Golden rule Financial Corporation - Political Action Committee
7440 Woodland Drive
Indianapolis, Indiana 46278
Relationship: Affiliated
Organization Type: Corporation

Committee ID# C00274431
UnitedHealth Group Incorporated Politi
9900 Bren Road East
Minnetonka, Minnesota 55343
Relationship: Affiliated
Organization Type: Corporation

Custodian of Records:

Mr. Daniel D. Willoth
14808 Westbury Road
Rockville, MD 20853
Title: Treasurer
Phone # (301) 545-5914

Treasurer:

Mr. Daniel Willoth
14808 Westbury Road
Rockville, Maryland 20853
Title: Treasurer
Phone # (301) 545-5914

Designated Agent(s):

Banks or Depositories

First Union National Bank
P.O. Box 13327
Roanoke, Virginia 240407314

Signed: Mr. Daniel Willoth
Date Signed: 03/24/2004
Official Committee FAX: 3015455385

(End FEC FORM 1)

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