FEC Form 1 for OHIO PROVIDER RESOURCE ASSOCIATION PACForm 1 for OHIO PROVIDER RESOURCE ASSOCIATION PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-130398

1. OHIO PROVIDER RESOURCE ASSOCIATION PAC

30 SPRUCE ST
COLUMBUS, OH 43215

2. Date: 08/05/2004

3. FEC Committee ID #: C00387282

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

Ohio Provider Resource Association
30 Spruce Street
Columbus, Ohio 43215
Relationship: Sponsor
Organization Type: Corporation W/O Capital Stock

Custodian of Records:

Scott Pullins, Esq.
50 West Broad Street Suite 1328
Post Office Box 163339
Columbus, OH 432163339
Title: Dep. Treasurer
Phone # (614) 224-3207

Treasurer:

Maureen Corcoran
30 Spruce Street
Columbus, Ohio 43215
Title: Treasurer

Designated Agent(s):

Scott Pullins, Esq.
50 West Broad Street Suite 1328
Post Office Box 163339
Columbus, Ohio 432163339
Title: Deputy Treasurer
Phone # (614) 224-3207

Maureen Corcoran
30 Spruce Street
Columbus, Ohio 43215
Title: Treasurer

Banks or Depositories

Signed: Maureen Corcoran
Date Signed: 08/05/2004

(End FEC FORM 1)

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