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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-427249

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1. Health Alliance Plan PAC

    2850 West Grand Boulevard
    Detroit, MI 48202
    Email: alcox@comerica.com

2. Date: 07/28/2009

3. FEC Committee ID #: C00410670 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

HEALTH ALLIANCE PLAN
2850 WEST GRAND BOULEVARD
DETROIT, Michigan 48202
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Comerica Bank
PAC Services MC 2250
P.O. Box 75000
Detroit, MI 482752250
Title: Recordkeeper
Phone # (248) 371-5562

Treasurer:

Ronald S. Siemiontkowski
Comerica Bank - PAC Services MC 22
P.O. Box 75000
Detroit, Michigan 482752250
Title: Treasurer
Phone # (248) 371-7271

Designated Agent(s):

Banks or Depositories

COMERICA BANK
P.O. BOX 75000
MC 2250
DETROIT, Michigan 482752250

Signed: Ronald S. Siemiontkowski
Date Signed: 07/28/2009

FORM TEXT

(End FEC FORM 1)

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