FEC Form 1 for American Association of Nurse Anesthetists Separate Segregated Fund (CRNA-PAC)Form 1 for American Association of Nurse Anesthetists Separate Segregated Fund (CRNA-PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-417719

1. American Association of Nurse Anesthetists Separate Segregated Fund (CRNA-PAC)

222 South Prospect Ave
c/o Finance Department
Park Ridge, IL 600684001
Email: crnapacfec@aanadc.com

2. Date: 05/19/2009

3. FEC Committee ID #: C00173153 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Association of Nurse Anesthetists
222 South Prospect Avenue
c/o Finance Department
Park Ridge, Illinois 60068
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jan Benjamin
222 South Prospect Avenue
c/o Finance Department
Park Ridge, IL 60068
Title: Controller

Treasurer:

Frank J Purcell
25 Massachusetts Ave, NW #550
Washington, DC 20001
Title: Senior Director, Fed
Phone # (202) 484-8400

Designated Agent(s):

Frank Purcell
25 Massachusetts Ave, NW #550
Washington, DC 20001
Title: Senior Director, Fed
Phone # (202) 484-8400

Banks or Depositories

JP Morgan Chase Bank NA
10 South Dearborn Street
Chicago, Illinois 606032003

Signed: Frank J Purcell
Date Signed: 05/19/2009

(End FEC FORM 1)

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