FEC Form 1 for National Association of Rehabilitation Providers &Agencies Inc. Political Action CommitteeForm 1 for National Association of Rehabilitation Providers &Agencies Inc. Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-410647

1. National Association of Rehabilitation Providers &Agencies Inc. Political Action Committee

1 Park West Circle
Suite 108
Midlothian, VA 23114
Email: mgkelley@wms-jen.com

2. Date: 04/01/2009

3. FEC Committee ID #: C00192153 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Custodian of Records:

Meredith Kelley
1155 21st ST, NW
Suite 300
Washington, DC 20036
Phone # (202) 659-8201

Treasurer:

Ted Botens
1 Park West Circle
Suite 108
Midlothian, Virginia 23113
Title: Treasurer

Designated Agent(s):

Meredith Kelley
1155 21st ST, NW
Suite 300
Washington, DC 20036
Title: Asst. Treasurer
Phone # (202) 659-8201

Banks or Depositories

Chain Bridge Bank
1445-A Laughlin Avenue
McLean, Virginia 22101

Signed: Ted Botens
Date Signed: 04/01/2009

(End FEC FORM 1)

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