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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1111708

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1. American Insurance Association Political Action Committee

    555 12th Street, NW
    Suite 550
    Washington, DC 20004

    NOTE: Address is different than previously reported

    Email: lpusey@aiadc.org

2. Date: 10/20/2016

3. FEC Committee ID #: C00103143 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

American Insurance Association
555 12th Street, NW
Suite 550
Washington, DC 20004
Affiliated Relationship Code: Connected Organization

Custodian of Records:

J. Stephen Zielezienski
555 12th Street, NW
Suite 550
Washington, DC 20004
Title: Assistant Treasurer
Phone # (202) 828-7100

Treasurer:

Mrs. Leigh Ann Pusey
555 12th Street, NW
Suite 550
Washington, DC 20004
Title: Treasurer
Phone # (202) 828-7100

Designated Agent(s):

J. Stephen Zielezienski
555 12th Street, NW
Suite 550
Washington, DC 20004
Title: Assistant Treasurer
Phone # (202) 828-7100

Banks or Depositories

Wells Fargo Bank
1100 Connecticut Avenue, NW
Washington, DC 20036

Signed: Mrs. Leigh Ann Pusey
Date Signed: 10/20/2016

(End FEC FORM 1)

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