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-1189770

1. American Health Care Association Political Action Committee

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

NOTE: Email address is different than previously reported

2. Date: 10/26/2017

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. Phil Fogg, Jr.
4560 SE International Way
Suite 100
Milwaukie, Oregon 97222
Title: Treasurer
Phone # (971) 206-5202

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-1189770

1. American Health Care Association Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 10/26/2017

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Phil Fogg, Jr.
Date Signed: 10/26/2017

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1189770

1. American Health Care Association Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 10/26/2017

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mr. Phil Fogg, Jr. Date Signed: 10/26/2017

(End FEC FORM 1)

Signed: Mr. Phil Fogg, Jr.
Date Signed: 10/26/2017