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-779834

1. Physician Hospitals of America Political Action Committee

PO Box 70980
Washington, DC 20024
Email: info@physicianhospitals.org

2. Date: 04/17/2012

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

Affiliated Committees/Organizations

Physician Hospitals of America
2025 M Street NW
Suite 800
Washington, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

John Richardson
PO Box 70980
Washington, DC 20024
Title: Treasurer
Phone # (202) 367-1113

Treasurer:

John Richardson
PO Box 70980
Washington, DC 20024
Title: Treasurer
Phone # (202) 367-1113

Designated Agent(s):

Banks or Depositories

PNC Bank
1799 Columbia Road NW
Washington, DC 20009

Signed: John Richardson
Date Signed: 04/20/2012

(End FEC FORM 1)

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