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FEC Form 1 for INVACARE CORPORATION POLITICAL ACTION COMMITTEE AKA INVA PACForm 1 for INVACARE CORPORATION POLITICAL ACTION COMMITTEE AKA INVA PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-744758

1. INVACARE CORPORATION POLITICAL ACTION COMMITTEE AKA INVA PAC

    ONE INVACARE WAY
    ELYRIA, OH 44035
    Email: jfox@invacare.com

    NOTE: Email address is different than previously reported

2. Date: 09/15/2011

3. FEC Committee ID #: C00249896 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

INVACARE CORPORATION
ONE INVACARE WAY
ELYRIA, Ohio 44035
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jerome E Fox, Jr.
Invacare Corporation
One Invacare Way
Elyria, OH 44035
Title: Treasurer
Phone # (440) 329-6102

Treasurer:

Jerome E Fox, Jr.
Invacare Corporation
One Invacare Way
Elyria, Ohio 44035
Title: Treasurer
Phone # (440) 329-6102

Designated Agent(s):

RONALD RICHESON
ONE INVACARE WAY
ELYRIA, Ohio 44035
Title: ASST TREASURER
Phone # (440) 329-6883

Banks or Depositories

PNC Bank
1900 East Ninth Street
Cleveland, Ohio 44114

Signed: Jerome E Fox, Jr.
Date Signed: 09/15/2011

(End FEC FORM 1)


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