FEC Form 1 for American Insurance Association Political Action CommitteeForm 1 for American Insurance Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-73480

1. American Insurance Association Political Action Committee

1130 Connecticut Avenue NW
Suite 1000
Washington, DC 20036

2. Date: 06/08/2001

3. FEC Committee ID #: C00103143 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American Insurance Association
1130 Connecticut Avenue NW
Suite 1000
Washington, DC 20036
Relationship: Connected Organizations
Organization Type: Trade Association

Custodian of Records:

Leigh Pusey
1130 Connecticut Avenue NW
Suite 1000
Washington, DC 20036
Title: Treasurer
Phone # (202) 828-7100

Treasurer:

Leigh Pusey
1130 Connecticut Avenue NW
Suite 1000
Washington, DC 20036
Title: Treasurer
Phone # (202) 828-7100

Designated Agent(s):

Joseph Quigley
1130 Connecticut Avenue NW
Suite 1000
Washington, DC 20036
Title: Assistant Treasurer
Phone # (202) 828-7100

Banks or Depositories

First Union Bank N.A.
1100 Connecticut Avenue NW
Washington, DC 20036

Signed: Ms. Leigh Ann Pusey
Date Signed: 01/16/2003

(End FEC FORM 1)

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