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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-280890

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1. FEDERATION OF AMERICAN HOSPITALS PAC

    801 PENNSYLVANIA AVENUE
    SUITE 245
    WASHINGTON, DC 200042604
    Email: jmicklos@fah.org

2. Date: 03/14/2007

3. FEC Committee ID #: C00002261 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Federation of American Hospitals
801 Pennsylvania Ave. NW
Suite 245
Washington, DC 20004
Relationship: Connected
Organization Type: Trade Association

Custodian of Records:

Mr. Alex Mullineaux
801 Pennsylvania Ave N.W.
Suite 245
Washington, DC 200042604
Title: PAC Director/Policy
Phone # (202) 624-1526

Treasurer:

Mr. Jeffrey Micklos
801 Pennsylvania Avenue N.W.
Suite 245
Washington, DC 200042604
Title: Senior Vice Presiden
Phone # (202) 624-1521

Designated Agent(s):

Mr. Jeffrey Micklos
801 Pennsylvania Ave. NW
Suite 245
Washington, DC 20004
Title: Treasurer
Phone # (202) 624-1521

Banks or Depositories

Wachovia National Bank
801 Pennsylvania Ave. NW
Washington, DC 20004

Signed: Mr. Jeffrey Micklos
Date Signed: 03/14/2007
Official Committee URL: http://www.fah.org

(End FEC FORM 1)

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