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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-835339

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1. North Carolina Hospital Association Political Action Committee - Federal

    P.O. Box 4449
    Cary, NC 275194449
    Email: ljones@ncha.org

2. Date: 11/29/2012

3. FEC Committee ID #: C00194647 This committee is a separate segregated fund. Its connected organization is a Trade Association
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

North Carolina Hospital Association
Post Office Box 4449
Cary, North Carolina 27519
Affiliated Relationship Code: Connected Organization

American Hospital Association Politica
325 Seventh St, NW
Washington, DC 20004
Affiliated Relationship Code: Affiliated Committee

AzHHA Political Action Committee
3901 N. Central Ave.
Phoenix, Arizona 85012
Affiliated Relationship Code: Affiliated Committee

California Healthcare Association PAC
P.O. Box 1100
Sacramento, California 958121100
Affiliated Relationship Code: Affiliated Committee

PAC of Missouri Hospital Association
P.O. Box 60
Jefferson City, Missouri 65102
Affiliated Relationship Code: Affiliated Committee

Montana Hospital Association PAC - Fed
P.O. Box 1519
Helena, Montana 59604
Affiliated Relationship Code: Affiliated Committee

Health Alliance Political Action Commi
4750 Lindle Road
Harrisburg, Pennsylvania 17105
Affiliated Relationship Code: Affiliated Committee

THA - The Association of Texas Hospita
P.O. Box 679010
Austin, Texas 78767
Affiliated Relationship Code: Affiliated Committee

Healthcare Association of Hawaii PAC
923 Ward Avenue
Honolulu, Hawaii 96814
Affiliated Relationship Code: Affiliated Committee

New York State Hospital and Healthcare
One Empire Drive
Rensselaer, New York 12144
Affiliated Relationship Code: Affiliated Committee

Wisconsin Health and Hospital Associat
P.O. Box 259038
Madison, Wisconsin 53725
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Treasurer:

Mr. Cody Hand
P.O. Box 4449
Cary, North Carolina 275194449
Title: Vice President and D
Phone # (919) 677-4113

Designated Agent(s):

Banks or Depositories

BB&T
1821 S. Main St.
Wake Forest, North Carolina 27587

Signed: Mr. Cody Hand
Date Signed: 11/29/2012

FORM TEXT

(End FEC FORM 1)

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