FEC Form 1 for American Academy of Physician Assistants Political Action Committee (PA PAC)Form 1 for American Academy of Physician Assistants Political Action Committee (PA PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-775009

1. American Academy of Physician Assistants Political Action Committee (PA PAC)

2318 Mill Road
Suite 1300
Alexandria, VA 22314
Email: pac@aapa.org

2. Date: 03/13/1980

3. FEC Committee ID #: C00122499 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

American Academy of Physician Assistants
2318 Mill Road
Suite 1300
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

James G. Potter
2318 Mill Road
Suite 1300
Alexandria, VA 22314
Title: SVP, Advocacy & Ops
Phone # (571) 319-4305

Treasurer:

Jennifer L. Dorn
2318 Mill Road
Suite 1300
Alexandria, Virginia 22314
Title: CEO
Phone # (571) 319-4301

Designated Agent(s):

Banks or Depositories

Bank of America
730 15th Street NW
Washington, DC 20005

Signed: Jennifer L. Dorn
Date Signed: 04/11/2012

(End FEC FORM 1)

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