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-1034748

1. American Health Care Association Political Action Committee

PO Box 75357
Washington, DC 20013
Email: wgriffith@ahca.org

2. Date: 12/04/2015

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:

Ms. Robin Hillier
1161 Green Knoll Drive
Westerville, Ohio 43081
Title: Treasurer
Phone # (614) 844-6686

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-1034748

1. American Health Care Association Political Action Committee

2. Date: 12/04/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Ms. Robin Hillier
Date Signed: 12/04/2015

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1034748

1. American Health Care Association Political Action Committee

2. Date: 12/04/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Ms. Robin Hillier Date Signed: 12/04/2015

(End FEC FORM 1)

Signed: Ms. Robin Hillier
Date Signed: 12/04/2015