FEC Form 1 for American Nurses Association PACForm 1 for American Nurses Association PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-809522

1. American Nurses Association PAC

8515 Georgia Avenue
Suite 400
Silver Spring, MD 20910
Email: Angela.Song@ana.org;Rose.Gonzalez@ana.org

2. Date: 09/07/2012

3. FEC Committee ID #: C00017525 This committee is a separate segregated fund. Its connected organization is a Labor Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Nurses Association
8515 Georgia Ave
Ste 400
Silver Spring, Maryland 209103492
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Angela Song
8515 Georgia Ave #400
Silver Spring, MD 209103492
Title: Custodian of Records
Phone # (301) 628-5096

Treasurer:

Dr. Thomas Ray Coe
209 Waterdown Dr #10
Fayetteville, North Carolina 28314
Title: Treasurer

Designated Agent(s):

Rose Iris Gonzalez
3318 Cullers Ct
Woodbridge, Virginia 221921085
Title: Assistant Treasurer

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-809522

1. American Nurses Association PAC

2. Date: 09/07/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Dr. Thomas Ray Coe
Date Signed: 09/14/2012

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-809522

1. American Nurses Association PAC

2. Date: 09/07/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Dr. Thomas Ray Coe Date Signed: 09/14/2012

(End FEC FORM 1)

Signed: Dr. Thomas Ray Coe
Date Signed: 09/14/2012