FEC Form 1 for NEW YORK STATE ASSOCIATION OF HEALTH CARE PROVIDERS INC FEDERAL PAC (HCP FEDERAL PAC)Form 1 for NEW YORK STATE ASSOCIATION OF HEALTH CARE PROVIDERS INC FEDERAL PAC (HCP FEDERAL PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-417652

1. NEW YORK STATE ASSOCIATION OF HEALTH CARE PROVIDERS INC FEDERAL PAC (HCP FEDERAL PAC)

99 Troy Road - Suite 200
East Greenbush, NY 120611065
Email: dworakowski@nyshcp.org

2. Date: 05/05/2009

3. FEC Committee ID #: C00307637 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

New York State Association of Health Care Providers, Inc
99 Troy Rd., Suite 200
East Greenbush, New York 12061
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Todd Brason
58 Tudor Place
Buffalo, New York 14222
Title: Treasurer
Phone # (716) 783-8288

Designated Agent(s):

Phyllis A. Wang, Asst. Treasurer
16 Leaward Way
Saratoga Springs, New York 12866
Title: Asst. Treasurer
Phone # (518) 583-4862

Banks or Depositories

Pioneer Bank
21 Second Street
Troy, New York 12180

Signed: Phyllis A Wang , Asst. Treasurer
Date Signed: 05/19/2009

(End FEC FORM 1)

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