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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-730502

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1. FEDERATION OF AMERICAN HOSPITALS PAC

    750 9th Street NW
    Suite 600
    WASHINGTON, DC 20001

    NOTE: Address is different than previously reported

    Email: csmith@fah.org

2. Date:

3. FEC Committee ID #: C00002261 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Federation of American Hospital
750 9th Street NW
Suite 600
Washington, DC 20001
Affiliated Relationship Code: Connected Organization

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:

Mrs. Karen Conwell Smith
801 Pennsylvania Avenue, N.W.
Suite 245
Washington, DC 200042604
Title: Vice President
Phone # (202) 624-1528

Designated Agent(s):

Karen Conwell Smith
750 9th Street NW
Suite 600
Washington, DC 20001
Title: VP, Legislation
Phone # (202) 624-1500

Banks or Depositories

Wachovia Bank
801 Pennsylvania Ave. NW
Washington, DC 20004

Signed: Mrs. Karen Conwell Smith
Date Signed: 04/29/2011

FORM TEXT

(End FEC FORM 1)

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