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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1105246

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1. The Hospital and Healthsystem Association of Pennsylvania - Federal Political Action Committee (HAPAC-Federal)

    30 North Third Street
    Suite 600
    Harrisburg, PA 17101

    NOTE: Address is different than previously reported

    Email: sbishop@haponline.org,sfischer@haponline.org

2. Date: 10/13/2016

3. FEC Committee ID #: C00128082 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

The Hospital & Healthsystem Association of Pennsylvania
30 North Third Street
Suite 600
Harrisburg, Pennsylvania 17101
Affiliated Relationship Code: Connected Organization

American Hospital Association PAC
325 7th St. NW Suite 700
Washington, DC 20004
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Mrs. Tina Latin-True
30 North Third Street
Harrisburg, PA 17101
Title: Sr VP Business Devel
Phone # (717) 561-5311

Treasurer:

Mr Scott Bishop
30 North Third St
Suite 600
Harrisburg, Pennsylvania 17101
Title: Sr VP. Legislative A
Phone # (717) 561-5235

Designated Agent(s):

Tina Latin-True
30 North Third St.
Suite 600
Harrisburg, Pennsylvania 17101
Title: Sr VP Business Devel
Phone # (717) 561-5311

Banks or Depositories

First National Bank
101 North 2nd Street
Harrisburg, Pennsylvania 17101

Signed: Mr Scott Bishop
Date Signed: 10/13/2016

FORM TEXT-1

(End FEC FORM 1)

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