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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-325464

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1. American Health Care Association Political Action Committee

    1201 L Street, NW
    Washington, DC 20005
    Email: hcutler@ahca.org

2. Date: 01/25/2008

3. FEC Committee ID #: C00006080 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00006080
American Health Care Association
1201 L Street, NW
Washington, DC 20005
Relationship: Affiliate
Organization Type: Membership Organization

Custodian of Records:

Ms. Heather A. Cutler
1201 L Street, NW
Washington, DC 20005
Title: Director, AHCA-PAC
Phone # (202) 898-2856

Treasurer:

Ms. Gail Clarkson
1201 L Street, NW
Washington, DC 20005
Title: Treasurer
Phone # (202) 898-2856

Designated Agent(s):

Ms. Heather A. Cutler
1201 L Street, NW
Washington, DC 20005
Title: Direcotr, AHCA-PAC
Phone # (202) 898-2856

Banks or Depositories

BB&T
P.O. Box 819
Wilson, North Carolina 27894

Signed: Ms. Gail Clarkson
Date Signed: 03/03/2008

(End FEC FORM 1)

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