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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1084380

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

    1341 G STREET NW
    Suite 600
    WASHINGTON, DC 20036

    NOTE: Address is different than previously reported

    Email: info@supplychainassociation.org;tebert@supplychainassociation.org

2. Date: 07/14/2016

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
1341 G Street NW
Suite 600
Washington, DC 20005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Todd C Ebert
1341 G Street NW
Suite 600
Washington, DC 20005
Title: Treasurer
Phone # (202) 629-5835

Treasurer:

Todd C Ebert
1341 G Street NW
Suite 600
Washington, DC 20005
Title: Treasurer
Phone # (202) 629-5835

Designated Agent(s):

Lee Perlman
1341 G Street NW
Suite 600
Washington, DC 20005
Title: Assistant Treasurer
Phone # (202) 629-5835

Banks or Depositories

M&T Bank
1680 K St., NW
Washington, DC 20006

Signed: Todd C Ebert
Date Signed: 07/14/2016

(End FEC FORM 1)

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