FEC Form 1 for American Health Care Association Political Action CommitteeForm 1 for American Health Care Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1030806

1. American Health Care Association Political Action Committee

PO Box 75357
Washington, DC 20013

NOTE: Address is different than previously reported

Email: wgriffith@ahca.org

2. Date: 10/22/2015

3. FEC Committee ID #: C00006080 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

Committee ID# C00006080
American Health Care Association
1201 L Street NW
Washington, DC 20005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Kim Zimmerman
1201 L Street NW
Washington, DC 20005
Title: Custodian of Records
Phone # (202) 898-2844

Treasurer:

Mr. Michael Wylie
205 Fairview Road
Clarks Green, Pennsylvania 18411
Title: Treasurer
Phone # (570) 430-5832

Designated Agent(s):

Kim Zimmerman
1201 L Street NW
Washington, DC 20005
Title: Custodian of Records
Phone # (202) 898-2844

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1030806

1. American Health Care Association Political Action Committee

NOTE: Address is different than previously reported

2. Date: 10/22/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Michael Wylie
Date Signed: 10/22/2015

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1030806

1. American Health Care Association Political Action Committee

NOTE: Address is different than previously reported

2. Date: 10/22/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Michael Wylie Date Signed: 10/22/2015

(End FEC FORM 1)

Signed: Mr. Michael Wylie
Date Signed: 10/22/2015