FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1037657
1. PROSPECT MEDICAL HOLDINGS, INC. POLITICAL ACTION COMMITTEE (PROSPECTPAC)
2350 KERNER BLVD.SUITE 250
SAN RAFAEL, CA 94901
Email: FECFORM1@NMGOVLAW.COM
2. Date: 12/31/2015
3. FEC Committee ID #: C00600916 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
PROSPECT MEDICAL HOLDINGS, INC.10780 SANTA MONICA BLVD.
SUITE 400
LOS ANGELES, California 90025
Affiliated Relationship Code: Connected Organization
Custodian of Records:
JASON D. KAUNE2350 KERNER BLVD.
SUITE 250
SAN RAFAEL, CA 94901
Title: CUSTODIAN OF RECORDS
Phone # (415) 389-6800
Treasurer:
JASON D. KAUNE2350 KERNER BLVD.
SUITE 250
SAN RAFAEL, California 94901
Title: TREASURER
Phone # (415) 389-6800
Designated Agent(s):
JAMES W. CARSON2350 KERNER BLVD.
SUITE 250
SAN RAFAEL, California 94901
Title: ASSISTANT TREASURER
Phone # (415) 389-6800
Banks or Depositories
BANK OF MARIN504 TAMALPAIS DRIVE
CORTE MADERA, California 94925