FEC Form 1 for PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEEForm 1 for PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-523677

1. PHYSICIAN HOSPITALS OF AMERICA POLITICAL ACTION COMMITTEE

5900 South Western Avenue
Suite 102
Sioux Falls, SD 57108
Email: keri@physicianhospitals.org

2. Date: 12/08/2010

3. FEC Committee ID #: C00394163 This committee is a separate segregated fund. Its connected organization is a
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

PHYSICIAN HOSPITALS OF AMERICA
5900 South Western Avenue
Suite 102
Sioux Falls, South Dakota 57108
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Keri Bolte
5900 South Western Avenue
Suite 102
Sioux Falls, SD 57108
Title: Interim Exec. Dir.
Phone # (605) 275-5350

Treasurer:

R. Blake Curd
5900 South Western Avenue
Suite 102
Sioux Falls, South Dakota 57108
Title: Treasurer
Phone # (605) 275-5349

Designated Agent(s):

Keri Bolte
5900 South Western Avenue
Suite 102
Sioux Falls, South Dakota 57108
Title: Interim Exec. Dir.
Phone # (605) 275-5350

Banks or Depositories

Wells Fargo Bank
P.O. Box 5128
Sioux Falls, South Dakota 571175128

Signed: R. Blake Curd
Date Signed: 10/08/2010
Official Committee URL: None

FORM TEXT

(End FEC FORM 1)

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