FEC Form 1 for HEALTHCARE SUPPLY CHAIN ASSOCIATION POLITICAL ACTION COMMITTEE (HSCA PAC)Form 1 for HEALTHCARE SUPPLY CHAIN ASSOCIATION POLITICAL ACTION COMMITTEE (HSCA PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1038353

1. HEALTHCARE SUPPLY CHAIN ASSOCIATION POLITICAL ACTION COMMITTEE (HSCA PAC)

2025 M STREET NW SUITE 800
WASHINGTON, DC 20036
Email: info@supplychainassociation.org;tebert@supplychainassociation.org

2. Date: 01/07/2016

3. FEC Committee ID #: C00423863 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

Healthcare Supply Chain Association
2025 M Street NW
Suite 800
Washington, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Todd C Ebert
2025 M Street NW
Suite 800
Washington, DC 20036
Title: Treasurer
Phone # (202) 367-1248

Designated Agent(s):

Banks or Depositories

SunTrust Bank
PO Box 305183
Nashville, Tennessee 372305183

Signed: Todd C Ebert
Date Signed: 01/07/2016

(End FEC FORM 1)

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