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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-732705

1. American Hospital Association PAC

325 Seventh Street, NW
Suite 700
Washington, DC 20004
Email: lwerner@aha.org

2. Date: 06/23/2011

3. FEC Committee ID #: C00106146 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

American Hospital Association
325 Seventh Street, NW
Suite 700
Washington, DC 20004
Affiliated Relationship Code: Connected Organization

CA Hospital Association PAC-Federal
1215 K Street, Suite 800
Sacramento, California 95814
Affiliated Relationship Code: Affiliated Committee

PAC of the Arizona Hospital & Healthca
2901 North Central Avenue
Suite 900
Phoenix, Arizona 85012
Affiliated Relationship Code: Affiliated Committee

PAC of Missouri Hospital Association
P.O. Box 60
Jefferson City, Missouri 65102
Affiliated Relationship Code: Affiliated Committee

Montana Hospital Association PAC - Fed
P.O. Box 5119
Helena, Montana 59604
Affiliated Relationship Code: Affiliated Committee

North Carolina Hospital Association PA
P.O. Box 4449
Cary, North Carolina 27519
Affiliated Relationship Code: Affiliated Committee

Hospital and Healthsystem Assoc of PA
P.O. Box 8600
Harrisburg, Pennsylvania 17105
Affiliated Relationship Code: Affiliated Committee

HOSPAC - Federal PAC of the Texas Hosp
P.O. Box 679010
Austin, Texas 78767
Affiliated Relationship Code: Affiliated Committee

New York State Hospital and Healthcare
One Empire Drive
Rensselaer, New York 12144
Affiliated Relationship Code: Affiliated Committee

Wisconsin Hospital Association Inc. Fe
P.O. Box 259038
Madison, Wisconsin 53725
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Ms. Laura Werner
325 Seventh Street, NW
Suite 700
Washington, DC 20004
Title: Associate Director,
Phone # (202) 626-2271

Treasurer:

Ms. Melinda Hatton
325 Seventh Street, NW
Suite 700
Washington, DC 20004
Title: Treasurer
Phone # (202) 626-2336

Designated Agent(s):

Banks or Depositories

Citibank
1400 G Street, NW
Washington, DC 20005

TD Bank
605 14th Street, NW
Washington, DC 20005

Signed: Ms. Melinda Hatton
Date Signed: 06/27/2011

FORM TEXT

(End FEC FORM 1)

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