FEC Form 1 for Hawaii Medical Service Association Employee Political Action CommitteeForm 1 for Hawaii Medical Service Association Employee Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-209779

1. Hawaii Medical Service Association Employee Political Action Committee

818 Keeaumoku Street
Honolulu, HI 96814
Fax: 8089486860
Email: PACinfo@hmsa.com

2. Date: 01/03/2006

3. FEC Committee ID #: C00321992 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Hawaii Medical Service Association
818 Keeaumoku Street
Honolulu, Hawaii 96814
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Jennifer Diesman
P.O. Box 860
Honolulu, HI 968080860
Title: Director
Phone # (808) 948-5459

Treasurer:

Ms. Carolyn Gire
5628 Halekamani Street
Honolulu, Hawaii 96825
Title: Treasurer
Phone # (808) 948-6588

Designated Agent(s):

Dr. Mike Sayama
2612 A Peter Street
Honolulu, Hawaii 96816
Title: Chair
Phone # (808) 948-5173

Banks or Depositories

First Hawaiian Bank
University Banking Center
2411 South King Street
Honolulu, Hawaii 96826

Signed: Ms. Carolyn Gire
Date Signed: 01/04/2006
Official Committee FAX: 8089486860

(End FEC FORM 1)

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