FEC Form 1 for PROSPECT MEDICAL HOLDINGS, INC. POLITICAL ACTION COMMITTEE (PROSPECTPAC)Form 1 for PROSPECT MEDICAL HOLDINGS, INC. POLITICAL ACTION COMMITTEE (PROSPECTPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1184042

1. PROSPECT MEDICAL HOLDINGS, INC. POLITICAL ACTION COMMITTEE (PROSPECTPAC)

2350 KERNER BLVD., SUITE 250
SAN RAFAEL, CA 94901
Email: FECFORM1@NMGOVLAW.COM

2. Date: 10/03/2017

3. FEC Committee ID #: C00600916 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

PROSPECT MEDICAL HOLDINGS, INC.
10780 SANTA MONICA BLVD., STE 400
LOS ANGELES, California 90025
Affiliated Relationship Code: Connected Organization

Custodian of Records:

JASON D. KAUNE
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, CA 94901
Title: Custodian of Records
Phone # (415) 389-6800

Treasurer:

JASON D. KAUNE
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Treasurer
Phone # (415) 389-6800

Designated Agent(s):

MICHAEL A. COLUMBO
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Assistant Treasurer
Phone # (415) 389-6800

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1184042

1. PROSPECT MEDICAL HOLDINGS, INC. POLITICAL ACTION COMMITTEE (PROSPECTPAC)

2. Date: 10/03/2017

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: MICHAEL A. COLUMBO
Date Signed: 09/26/2017

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1184042

1. PROSPECT MEDICAL HOLDINGS, INC. POLITICAL ACTION COMMITTEE (PROSPECTPAC)

2. Date: 10/03/2017

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: MICHAEL A. COLUMBO Date Signed: 09/26/2017

(End FEC FORM 1)

Signed: MICHAEL A. COLUMBO
Date Signed: 09/26/2017