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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-782545

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1. American Insurance Association Political Action Committee

    2101 L Street, NW
    Suite 400
    Washington, DC 20037
    Email: lpusey@aiadc.org

2. Date: 05/10/2012

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
2101 L Street, NW
Suite 400
Washington, DC 20037
Affiliated Relationship Code: Connected Organization

Custodian of Records:

J. Stephen Zielezienski
2101 L Street, NW
Suite 400
Washington, DC 20037
Title: Assistant Treasurer
Phone # (202) 828-7100

Treasurer:

Leigh Ann Pusey
2101 L Street, NW
Suite 400
Washington, DC 20037
Title: Treasurer
Phone # (202) 828-7100

Designated Agent(s):

J. Stephen Zielezienski
2101 L Street, NW
Suite 400
Washington, DC 20037
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: 05/10/2012

(End FEC FORM 1)

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