FEC Form 1 for American Health Care Association Political Action CommitteeForm 1 for American Health Care Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-407899

1. American Health Care Association Political Action Committee

1201 L Street, NW
Washington, DC 20005
Email: saman@ahca.org

NOTE: Email address is different than previously reported

2. Date: 03/17/2009

3. FEC Committee ID #: C00006080 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

Committee ID# C00006080
American Health Care Association
1201 L Street, NW
Washington, DC 20005

Custodian of Records:

Ms. Stacie S. Aman
1201 L Street, NW
Washington, DC 20005
Title: Director, AHCA-PAC
Phone # (202) 898-2856

Treasurer:

Ms. Gail Clarkson
1201 L Street, NW
Washington, DC 20005
Title: Treasurer
Phone # (202) 898-2856

Designated Agent(s):

Ms. Stacie S. Aman
1201 L Street, NW
Washington, DC 20005
Title: Direcotr, AHCA-PAC
Phone # (202) 898-2856

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-407899

1. American Health Care Association Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 03/17/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Ms. Gail Clarkson
Date Signed: 03/17/2009

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-407899

1. American Health Care Association Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 03/17/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Ms. Gail Clarkson Date Signed: 03/17/2009

(End FEC FORM 1)

Signed: Ms. Gail Clarkson
Date Signed: 03/17/2009