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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-352965

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1. American Nurses Association PAC

    8515 Georgia Ave
    Suite 400
    Silver Spring, MD 20910
    Fax: 3016285348
    Email: angela.song@ana.org

2. Date: 07/18/2008

3. FEC Committee ID #: C00017525 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

American Nurses Association
8515 Georgia Ave.
Suite 400
Silver Spring, Maryland 20910
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Angela Song
8515 Georgia Ave.
Suite 400
Silver Spring, MD 20910
Title: PAC Administrator
Phone # (301) 628-5096

Treasurer:

Mary Behrens
5504 E. 22nd St.
Suite 2200
Casper, Wyoming 82609
Title: PAC Treasurer
Phone # (301) 628-5096

Designated Agent(s):

Rose Gonzalez
8515 Georgia Ave.
Suite 400
Silver Spring, Maryland 20910
Title: Assistant Treasurer
Phone # (301) 625-5098

Banks or Depositories

Bank of America
PO Box 2485
Spokane, Washington 99210

Signed: Mary Behrens
Date Signed: 07/18/2008
Official Committee FAX: 3016285348

(End FEC FORM 1)

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