FEC Form 1 for American Association of Nurse Anesthetists Separate Segregated Fund (CRNA-PAC)Form 1 for American Association of Nurse Anesthetists Separate Segregated Fund (CRNA-PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1500944

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: 02/19/2021

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. Ewa Herdea
222 S Prospect Avenue
Park Ridge, IL 60068
Title: Senior Director of F
Phone # (847) 655-1120

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. Ewa Herdea
222 S Prospect Avenue
Park Ridge, Illinois 60068
Title: Senior Director of F
Phone # (847) 655-1120

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1500944

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

2. Date: 02/19/2021

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Ralph Kohl
Date Signed: 02/19/2021

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1500944

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

2. Date: 02/19/2021

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Ralph Kohl Date Signed: 02/19/2021

(End FEC FORM 1)

Signed: Mr. Ralph Kohl
Date Signed: 02/19/2021