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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1378078

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1. AMERICA'S ESSENTIAL HOSPITALS POLITICAL ACTION COMMITTEE, (ESSENTIAL HOSPITALS PAC)

    401 9TH STREET, NW
    SUITE 900
    WASHINGTON, DC 20004
    Email: cjackson@essentialhospitals.org

2. Date: 01/31/2020

3. FEC Committee ID #: C00602805 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

America's Essential Hospitals
401 9th Street, NW
Suite 900
Washington, DC 20004
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Isabell Kaunan
401 9th Street, NW
Suite 900
Washington, DC 20006
Title: Custodian of Records

Treasurer:

Carlos Jackson
1762 Redwood Ter NW
Washington, DC 200121055
Title: Treasurer
Phone # (202) 585-0100

Designated Agent(s):

Margaret Peterson
490 M St SW
Washington, DC 200242612
Title: Assistant Treasurer
Phone # (202) 585-0551

Banks or Depositories

Bank of America
730 15th Street, NW
Washington, DC 20004

Signed: Carlos Jackson
Date Signed: 01/31/2020

(End FEC FORM 1)

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