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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1194893

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1. American Association of Nurse Anesthetists Separate Segregated Fund (CRNA-PAC)

    222 South Prospect Ave
    c/o Finance Department
    Park Ridge, IL 600684001
    Email: crnapacfec@aanadc.com

2. Date: 12/20/2017

3. FEC Committee ID #: C00173153 This committee is a separate segregated fund. Its connected organization is a Membership Organization
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Association of Nurse Anesthetists
222 South Prospect Ave
Park Ridge, Illinois 600684001
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms. Connie Calderaro
222 S. Prospect Avenue
Park, IL 60068
Title: Controller
Phone # (847) 939-3526

Treasurer:

Mr. Ralph Kohl
25 Massachusetts Ave. NW
Suite 320
Washington, DC 20001
Title: Sr. Director, Federa
Phone # (202) 484-8400

Designated Agent(s):

Ms. Connie Calderaro
222 S. Prospect Avenue
Park, Illinois 60068
Title: Controller
Phone # (847) 939-3526

Banks or Depositories

MB Financial
6111 North River Road
Rosemont, Illinois 60018

Signed: Mr. Ralph Kohl
Date Signed: 12/20/2017

(End FEC FORM 1)

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