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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-981457

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1. Americas Health Insurance Plans PAC (AHIP PAC)

    601 Pennsylvania Avenue, NW
    South Building, Suite 500
    Washington, DC 20004
    Email: cstellar@ahip.org

2. Date: 12/19/2014

3. FEC Committee ID #: C00106740 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

Americas Health Insurance Plans
601 Pennsylvania Avenue, NW
South Building, Suite 500
Washington, DC 20004
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Amber Manko
601 Pennsylvania Avenue, NW
South Building, Suite 600
Washington, DC 20004
Title: Deputy Director
Phone # (202) 861-6371

Treasurer:

Charles W. Stellar
601 Pennsylvania Avenue, NW
South Building, Suite 500
Washington, DC 20004
Title: EVP
Phone # (202) 778-3201

Designated Agent(s):

Mary Beth Donahue
601 Pennsylvania Avenue, NW
South Building, Suite 500
Washington, DC 20004
Title: EVP
Phone # (202) 778-8504

Banks or Depositories

Citibank
1101 Pennsylvania Ave, NW
11th Floor
Washington, DC 20004

Signed: Charles W. Stellar
Date Signed: 12/19/2014

(End FEC FORM 1)

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