FEC Form 1 for Health Industry Distributors Association Political Action CommitteeForm 1 for Health Industry Distributors Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-748083

1. Health Industry Distributors Association Political Action Committee

310 Montgomery Street
Alexandria, VA 22314
Email: Frazier@HIDA.org

NOTE: Email address is different than previously reported

2. Date: 10/14/2011

3. FEC Committee ID #: C00486498 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

Health Industry Distributors Association
310 Montgomery Street
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Vincent Tallman
1950 Roland Clarke Pl., Suite 300
Reston, VA 20191
Title: Custodian
Phone # (703) 476-3070

Treasurer:

Vincent Tallman
1950 Roland Clarke Pl., Suite 300
Reston, Virginia 20191
Title: Treasurer
Phone # (703) 476-3070

Designated Agent(s):

Lisa Queeney
310 Montgomery Street
Alexandria, Virginia 22314
Title: Assistant Treasurer
Phone # (703) 838-6124

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-748083

1. Health Industry Distributors Association Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 10/14/2011

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Vincent Tallman
Date Signed: 10/14/2011

FORM TEXT

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-748083

1. Health Industry Distributors Association Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 10/14/2011

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Vincent Tallman Date Signed: 10/14/2011 function popup748083F1() { plain_window = window.open('/dcdev/fectxt/748083F1.txt','plain','scrollbars,resizable,width=500,height=500'); } FORM TEXT

(End FEC FORM 1)

Signed: Vincent Tallman
Date Signed: 10/14/2011

FORM TEXT