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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-750375

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

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

    NOTE: Email address is different than previously reported

2. Date: 10/06/2011

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

Affiliated Committees/Organizations

Nat'lAssoc.ofRehabilitationProviders&Agencies,Inc.
12100 Sunset Hills Road
Suite 130
Reston, Virginia 20190
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Meredith Lesher
701 8th Street, NW
Suite 500
Washington, DC 20001
Phone # (202) 659-8201

Treasurer:

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

Designated Agent(s):

Meredith Lesher
701 8th Street, NW
Suite 500
Washington, DC 20001
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: 10/06/2011

(End FEC FORM 1)

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